=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891594545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEWED SPIRIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 N MAIN ST STE 9
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-244-9073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 PENN AVE
-----------------------------------------------------
City | LATROBE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15650-2370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-760-0119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | KENDRA HUBER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 412-760-0119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------