Provider Demographics
NPI:1568790608
Name:LIFE RENOVATIONS
Entity Type:Organization
Organization Name:LIFE RENOVATIONS
Other - Org Name:LIFE RENOVATIONS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITNI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KINKADE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:325-672-7055
Mailing Address - Street 1:318 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5722
Mailing Address - Country:US
Mailing Address - Phone:325-672-7055
Mailing Address - Fax:325-672-7066
Practice Address - Street 1:318 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5722
Practice Address - Country:US
Practice Address - Phone:325-672-7055
Practice Address - Fax:325-672-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60862101YP2500X
TX61386101YP2500X
TX64596101YP2500X
TX14842101YP2500X
TX34115103TC1900X
TX23019103TC1900X
TXH71332084P0804X
TX626151363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty