Provider Demographics
NPI:1063565711
Name:RENAISSANCE ONCOLOGY COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:RENAISSANCE ONCOLOGY COUNSELING ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERNETHY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:972-234-2333
Mailing Address - Street 1:PO BOX 450091
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-0091
Mailing Address - Country:US
Mailing Address - Phone:972-234-2333
Mailing Address - Fax:972-234-8964
Practice Address - Street 1:1221 ABRAMS RD STE 232
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5581
Practice Address - Country:US
Practice Address - Phone:972-234-2333
Practice Address - Fax:972-234-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11167101YM0800X
TX15900101YM0800X
TX18851101YM0800X
TXSO40531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030HNOtherBLUE CROSS
TX236213OtherMHN
TX0030HNOtherBLUE CROSS