Revived and Renewed Mental Health, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

REVIVED AND RENEWED MENTAL HEALTH, LLC

Practice address

4400 Ambassador Caffery Pkwy Ste A167
Lafayette, LA 70508-6760

Phone

(337) 450-0406

NPI assigned

Jul 20, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Brandy M Skidmore, MSW,LCSWNPI 1154722353

Title

LCSW/Owner

Phone

(337) 450-0406

Specialties & licenses 4

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandy Michelle Skidmore, LCSW

  • Clinical Social Worker
  • Carencro, LA
  • NPI 1154722353
  NPD Authorized official

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1376151969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 AMBASSADOR CAFFERY PKWY STE A167",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086760",
            "telephone_number": "337-450-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 AMBASSADOR CAFFERY PKWY STE A167",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086760",
            "telephone_number": "337-450-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVED AND RENEWED MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-20",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "SKIDMORE",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LCSW/OWNER",
        "authorized_official_telephone_number": "337-450-0406",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW,LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Adult Mental Health Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; 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.