Provider Demographics
NPI:1952820243
Name:RELATIONSHIP RENOVATION COUNSELING CENTER
Entity Type:Organization
Organization Name:RELATIONSHIP RENOVATION COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / LICENSED CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TARAH
Authorized Official - Middle Name:CARMODY
Authorized Official - Last Name:KERWIN
Authorized Official - Suffix:III
Authorized Official - Credentials:LMFT
Authorized Official - Phone:520-697-6179
Mailing Address - Street 1:1661 N SWAN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4075
Mailing Address - Country:US
Mailing Address - Phone:520-955-4809
Mailing Address - Fax:
Practice Address - Street 1:1717 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3074
Practice Address - Country:US
Practice Address - Phone:520-372-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZCSLG8288251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty