MEDICARE: MIND RENEWALS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053829598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND RENEWALS INC

Provider Business Mailing Address
First Line	:	1005 TILLMAN ST STE 217
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-2038
Country	:	US
Telephone Number	:	901-468-3349
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 TILLMAN ST STE 217
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-2038
Country	:	US
Telephone Number	:	901-468-3349
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	KIMBERLY ATKINS
Credential	:	EDD, LCSW
Telephone Number	:	901-468-3349

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	01/18/2018

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Directions to “MIND RENEWALS INC ” Practice Location

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