Renew Your Mind - Counseling Consulting and Supervision LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01151 Issued in MN

Legal business name

RENEW YOUR MIND - COUNSELING CONSULTING AND SUPERVISION LLC

Practice address

15561 Railroad St Ste 203a
Hayward, WI 54843-5703

Phone

(651) 347-1380

NPI assigned

Mar 9, 2018

Organization subpart

No

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

Authorized official

Name

Lesley M Boozell

Title

Credential Specialist

Phone

(218) 232-0856

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1699278283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9705N VIOLET LN",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548431179",
            "telephone_number": "651-380-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15561 RAILROAD ST STE 203A",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435703",
            "telephone_number": "651-347-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW YOUR MIND - COUNSELING CONSULTING AND SUPERVISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "BOOZELL",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIAL SPECIALIST",
        "authorized_official_telephone_number": "218-232-0856"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "302869",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Pullen, LADC AND LPCC, LPC
• Dawn Marcel Quaderer, RN
• Roxie Lynn Quaderer
• Jessica Renea Rands, APNP
• Realign and Reclamation, LLC
• Steven Charles Robbins, R.PH
• Adam Robert Rocksvold
• Kristen S Rodeheaver, APNP
• Karlye Nicole Rodriguez-Wisdom, M.D.
• Katlyn Rohr, SLP

• Professional Counselor in Hayward, WI
• Providers in Hayward, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.