Provider Demographics
NPI:1588377824
Name:RENASCENCE PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:RENASCENCE PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-591-4579
Mailing Address - Street 1:1209 PARK ST STE 301B
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7251
Mailing Address - Country:US
Mailing Address - Phone:805-591-4579
Mailing Address - Fax:
Practice Address - Street 1:1209 PARK ST STE 301B
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7251
Practice Address - Country:US
Practice Address - Phone:805-591-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366949943OtherNPI WHEN SOLE PROPRIETOR