Provider Demographics
NPI:1699150979
Name:RENEWING THE MIND PC
Entity type:Organization
Organization Name:RENEWING THE MIND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:712-271-6463
Mailing Address - Street 1:3930 STADIUM DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-5166
Mailing Address - Country:US
Mailing Address - Phone:712-271-6463
Mailing Address - Fax:712-271-6464
Practice Address - Street 1:3930 STADIUM DR STE 1
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5166
Practice Address - Country:US
Practice Address - Phone:712-271-6463
Practice Address - Fax:712-271-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01010103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty