Provider Demographics
NPI:1447817572
Name:RENEW MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:RENEW MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:870-243-0424
Mailing Address - Street 1:1150 E MATTHEWS AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4356
Mailing Address - Country:US
Mailing Address - Phone:870-243-0424
Mailing Address - Fax:534-248-4225
Practice Address - Street 1:1150 E MATTHEWS AVE STE 101A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4356
Practice Address - Country:US
Practice Address - Phone:870-243-0424
Practice Address - Fax:534-248-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty