Provider Demographics
NPI:1780358036
Name:RENEW YOU HEART HEALING
Entity type:Organization
Organization Name:RENEW YOU HEART HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:682-272-6559
Mailing Address - Street 1:1989 OBSIDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1179
Mailing Address - Country:US
Mailing Address - Phone:682-272-6559
Mailing Address - Fax:682-292-2895
Practice Address - Street 1:1989 OBSIDIAN TRL
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-1179
Practice Address - Country:US
Practice Address - Phone:682-272-6559
Practice Address - Fax:682-292-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1M1946Medicaid