| Mind Renew,llc | |
|
12211 W Bell Rd Surprise AZ 85378-9521 | |
| (404) 953-2501 | |
| Not Available |
| Full Name | Mind Renew,llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 12211 W Bell Rd, Surprise, Arizona |
| Authorized Official Name and Position | Shockie Dersno (OWNER) |
| Authorized Official Contact | 4049532501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Renew,llc 17569 W Banff Ln Surprise AZ 85388-7891 Ph: (404) 953-2501 | Mind Renew,llc 12211 W Bell Rd Surprise AZ 85378-9521 Ph: (404) 953-2501 |
| NPI Number | 1033740196 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 01/28/2020 |
| Certification Date | 01/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033740196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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