Mind Renwal

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

66609 Issued in TX

Legal business name

MIND RENWAL

Practice address

1636 N Hampton Rd
Suite 101
Desoto, TX 75115-8621

Phone

(817) 658-3812

NPI assigned

Jul 1, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Christine Jeffries, LPC

Title

Partner

Phone

(817) 239-8297

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467331200000",
    "number": "1083066013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 N HAMPTON RD",
            "address_2": "SUITE 101",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 N HAMPTON RD",
            "address_2": "SUITE 101",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751158621",
            "telephone_number": "817-658-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND RENWAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-01",
        "last_updated": "2016-07-01",
        "status": "A",
        "authorized_official_last_name": "JEFFRIES",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "817-239-8297",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "70275",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "66609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Desoto, TX
• Providers in Desoto, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.