Provider Demographics
NPI:1407436124
Name:RENEWED MIND COUNSELING LLC
Entity Type:Organization
Organization Name:RENEWED MIND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:SANCEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-931-0907
Mailing Address - Street 1:8453 LINDER CT
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2014
Mailing Address - Country:US
Mailing Address - Phone:773-931-0907
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 214
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:773-931-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty