Renewed Life Counseling, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

RENEWED LIFE COUNSELING, LLC

Doing business as

Renewed Life Counseling Services

Practice address

10026 University Ave NW Ste 103
Coon Rapids, MN 55448-2213

Phone

(612) 636-9677

NPI assigned

Jan 31, 2019

Organization subpart

No

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

Authorized official

Name

Nikisha Lynnette Simmons-Maclin, LADCNPI 1063870905

Title

Executive Director

Phone

(612) 636-9677

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Renewed Life Counseling Services Doing business as

Locations

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.

• Nikisha Lynnette Simmons-Maclin, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Coon Rapids, MN
  • NPI 1063870905
  NPD (past) Authorized official

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

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1811452188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10026 UNIVERSITY AVE NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482213",
            "telephone_number": "612-636-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10026 UNIVERSITY AVE NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482213",
            "telephone_number": "612-636-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWED LIFE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "SIMMONS-MACLIN",
        "authorized_official_first_name": "NIKISHA",
        "authorized_official_middle_name": "LYNNETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-636-9677",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA DEPARTMENT OF HUMAN SERVICES",
            "identifier": "1098948",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renewed Life Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; 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.