Provider Demographics
NPI:1669617841
Name:REJUVENATE INC
Entity type:Organization
Organization Name:REJUVENATE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SYMES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:816-812-6820
Mailing Address - Street 1:400 SW LONGVIEW BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2112
Mailing Address - Country:US
Mailing Address - Phone:816-761-3944
Mailing Address - Fax:866-335-7993
Practice Address - Street 1:400 SW LONGVIEW BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2112
Practice Address - Country:US
Practice Address - Phone:816-761-3944
Practice Address - Fax:866-335-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1531Medicare PIN