MEDICARE: RENEWED GRACE COUNSELING, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922956366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED GRACE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1210 MABLE NELL RD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-2964
Country	:	US
Telephone Number	:	479-806-3237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 MABLE NELL RD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-2964
Country	:	US
Telephone Number	:	479-806-3237
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	SHAWNDA ELAINE WEAR
Credential	:	LPC
Telephone Number	:	479-806-3237

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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