MEDICARE: RENEW MENTAL HEALTH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1164361390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW MENTAL HEALTH, PLLC

Provider Business Mailing Address
First Line	:	825 N CASS AVE STE 112
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-6401
Country	:	US
Telephone Number	:	708-303-8822
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 N CASS AVE STE 112
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-6401
Country	:	US
Telephone Number	:	708-303-8822
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA BULT
Credential	:	LCSW
Telephone Number	:	708-307-7291

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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