Provider Demographics
NPI:1518234194
Name:RENEWED COUNSELING SERVICE
Entity Type:Organization
Organization Name:RENEWED COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARI
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-289-8405
Mailing Address - Street 1:13051 GROVE PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5755
Mailing Address - Country:US
Mailing Address - Phone:210-289-8405
Mailing Address - Fax:210-679-6705
Practice Address - Street 1:1800 NE LOOP 410
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5213
Practice Address - Country:US
Practice Address - Phone:210-289-8405
Practice Address - Fax:210-679-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63113251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202676701Medicaid