Provider Demographics
NPI:1841678711
Name:PAX RENUEVO COUNSELING CENTER INC.
Entity type:Organization
Organization Name:PAX RENUEVO COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:407-870-0083
Mailing Address - Street 1:2408 STONEY WAY
Mailing Address - Street 2:APT. D
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5909
Mailing Address - Country:US
Mailing Address - Phone:321-948-9907
Mailing Address - Fax:
Practice Address - Street 1:290 COMPETITION DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8426
Practice Address - Country:US
Practice Address - Phone:407-870-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty