OrganizationActive
Mind Renew,llc
NPI 1033740196 · Mental Health Counselor · Surprise, AZ
Mind Renew,llc is a Mental Health Counselor organization in Surprise, AZ (NPI 1033740196).
Provider details
- NPI number
- 1033740196
- Entity type
- Organization
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Shockie Dersno, Owner(404) 953-2501
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(65/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
12211 W Bell Rd
Surprise, AZ 85378-9521
Phone: (404) 953-2501
Street-level locationGet directions
Mailing address
13807 W Country Gables Dr
Surprise, AZ 85379-8338
Registry dates
- Enumerated
- 2020-01-28
- Last updated
- 2025-07-01
- Certified
- 2025-07-01
Frequently asked questions
- What is Mind Renew,llc's NPI number?
- Mind Renew,llc's National Provider Identifier (NPI) is 1033740196, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mind Renew,llc?
- Mind Renew,llc is classified in the NPPES registry as Mental Health Counselor (Behavioral Health & Social Service Providers).
- Where is Mind Renew,llc located?
- Mind Renew,llc's practice location on file with NPPES is 12211 W Bell Rd, Surprise, AZ 85378-9521.
- What is Mind Renew,llc's phone number?
- The practice phone number listed in the NPPES registry for Mind Renew,llc is (404) 953-2501.
- Who is the authorized official for Mind Renew,llc?
- The authorized official listed on Mind Renew,llc's NPPES record is Shockie Dersno, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mind Renew,llc's NPI active?
- Yes — Mind Renew,llc's NPI (1033740196) is active in the NPPES registry as of the last update on 2025-07-01.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.