Provider Demographics
NPI:1538524582
Name:RENEWED MINDS PLLC
Entity type:Organization
Organization Name:RENEWED MINDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPREITOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:DR
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-420-8208
Mailing Address - Street 1:190 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2245
Mailing Address - Country:US
Mailing Address - Phone:662-420-8208
Mailing Address - Fax:
Practice Address - Street 1:190 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2245
Practice Address - Country:US
Practice Address - Phone:662-420-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1079661251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health