Renewed Mind Enrichment Therapy & Community Services Network

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RENEWED MIND ENRICHMENT THERAPY & COMMUNITY SERVICES NETWORK

Practice address

5506 W Chestnut Ave, Apt 222
5506 W Chestnut Ave, Apt 222
Enid, OK 73703

Phone

(580) 231-1659

Fax

(855) 629-7098

NPI assigned

Feb 9, 2022

Last updated

Feb 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Angela Michelle Jackson, PHD, LPCNPI 1952695652

Title

Owner & Licensed Professional Thera

Phone

(580) 231-1659

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angela Michelle Jackson, MCP, BHRS

  • Counselor
  • Enid, OK
  • NPI 1952695652
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1285388140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5506 W CHESTNUT AVE, APT 222",
            "address_2": "5506 W CHESTNUT AVE, APT 222",
            "city": "ENID",
            "state": "OK",
            "postal_code": "73703",
            "telephone_number": "580-231-1659",
            "fax_number": "855-629-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5506 W CHESTNUT AVE, APT 222",
            "address_2": "5506 W CHESTNUT AVE, APT 222",
            "city": "ENID",
            "state": "OK",
            "postal_code": "73703",
            "telephone_number": "580-231-1659",
            "fax_number": "855-629-7098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED MIND ENRICHMENT THERAPY & COMMUNITY SERVICES NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER & LICENSED PROFESSIONAL THERA",
        "authorized_official_telephone_number": "580-231-1659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reliant Direct Primary Care LLC
• Reliant Health & Wellness PLLC
• Renal Care Group of the Midwest (Renal Care Group Enid)
• Phillip Rendoff
• Sarah Lynn Reneski, BA, BHRS
• Viki Sharlaine Resler, D.C.
• Randall D Revels
• Krystal Rhyne
• Richard L. Devaughn D.D.S. Inc.
• Amber Michelle Richards, BSN, RN, IBCLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Enid, OK
• Providers in Enid, OK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.