Provider Demographics
NPI:1487229530
Name:RENU BRAIN TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:RENU BRAIN TREATMENT CENTER, LLC
Other - Org Name:RENU BRAIN TREATMENT CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSAY
Authorized Official - Middle Name:DENAE
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PA ABA
Authorized Official - Phone:816-321-1414
Mailing Address - Street 1:9237 WARD PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-3330
Mailing Address - Country:US
Mailing Address - Phone:816-312-1414
Mailing Address - Fax:
Practice Address - Street 1:9237 WARD PKWY STE 240
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3330
Practice Address - Country:US
Practice Address - Phone:816-799-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty