Provider Demographics
NPI:1255051611
Name:RENEWING DFW, PLLC
Entity type:Organization
Organization Name:RENEWING DFW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEYNAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-238-0211
Mailing Address - Street 1:210 N ECTOR DR UNIT 852
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-8630
Mailing Address - Country:US
Mailing Address - Phone:682-238-0211
Mailing Address - Fax:
Practice Address - Street 1:1550 NORWOOD DR STE 120
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3646
Practice Address - Country:US
Practice Address - Phone:682-238-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty