Provider Demographics
NPI:1194478248
Name:RENOVATION INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:RENOVATION INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BIGLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-297-6775
Mailing Address - Street 1:172 RAINBOW DR # 7240
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1072
Mailing Address - Country:US
Mailing Address - Phone:321-297-6775
Mailing Address - Fax:
Practice Address - Street 1:4602 CR 673 # 7240
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-8358
Practice Address - Country:US
Practice Address - Phone:321-297-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty