Provider Demographics
NPI:1649817370
Name:MIND RENEWAL TRANSFORMATIONAL CENTRE INC
Entity type:Organization
Organization Name:MIND RENEWAL TRANSFORMATIONAL CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEATS-CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-300-9165
Mailing Address - Street 1:2015 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-5038
Mailing Address - Country:US
Mailing Address - Phone:407-922-0511
Mailing Address - Fax:
Practice Address - Street 1:2303 AVELLINO AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8010
Practice Address - Country:US
Practice Address - Phone:074-818-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty