MEDICARE: RENEWING LIFE CENTER

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1699174839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWING LIFE CENTER

Provider Business Mailing Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-434-7290
Fax Number	:	702-434-6940

Provider Business Practice Location Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-434-7290
Fax Number	:	702-434-6940

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARK WHELCHECL
Credential	:	MFT
Telephone Number	:	702-434-7290

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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Directions to “RENEWING LIFE CENTER ” Practice Location

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