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General NPI Number Information
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NPI Number | 1912863929
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Entity Type | Organization
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Legal Business Name | RENASCENCE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/03/2026
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 5421 W 41ST ST STE 204
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City | SIOUX FALLS
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State | SD
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Zip | 57106-1300
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Country | US
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Telephone | 605-620-9565
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Fax |
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Provider Business Mailing Address
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Address Line | 5421 W 41ST ST STE 204
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City | SIOUX FALLS
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State | SD
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Zip | 57106-1300
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Country | US
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Telephone | 605-620-9565
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Fax |
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Authorized Official
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Title or Position | EXPRESSIVE THERAPIST/OWNER
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Name | JESSIE JEAN PARK
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Credential | LPC-MH, QMHP
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Telephone | 605-610-9565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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