Provider Demographics
NPI:1760950927
Name:RENAISSANCE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:RENAISSANCE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, MS, LMFTI
Authorized Official - Phone:702-241-8202
Mailing Address - Street 1:PO BOX 620251
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89162-0251
Mailing Address - Country:US
Mailing Address - Phone:702-241-8202
Mailing Address - Fax:
Practice Address - Street 1:4760 S PECOS RD STE 203-6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6038
Practice Address - Country:US
Practice Address - Phone:702-930-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)