1629661475 NPI number — RENEWING HOPE COUNSELING PLLC

Table of content: (NPI 1629661475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629661475 NPI number — RENEWING HOPE COUNSELING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENEWING HOPE COUNSELING PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629661475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2467 CAMBRIDGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAHLEQUAH
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74464-4688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-207-7099
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S MUSKOGEE AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-608-1600
Provider Business Practice Location Address Fax Number:
918-608-1601
Provider Enumeration Date:
02/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLANC
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICIAN
Authorized Official Telephone Number:
918-207-7099

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1689912560 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902233604 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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