MEDICARE: RENEWED LIFE COUNSELING GROUP PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1275496242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED LIFE COUNSELING GROUP PLLC

Provider Business Mailing Address
First Line	:	696 PROVIDENCE RD
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-4468
Country	:	US
Telephone Number	:	936-247-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E MILAM ST
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-2936
Country	:	US
Telephone Number	:	936-247-2774
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RUSTI GARCIA
Credential	:	MS, LPC
Telephone Number	:	936-247-2774

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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