Healthcare Provider Details

I. General information

NPI: 1417586355
Provider Name (Legal Business Name): RENEW COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 LAS ROSAS AVE
CLOVIS CA
93619-7937
US

IV. Provider business mailing address

1002 LAS ROSAS AVE
CLOVIS CA
93619-7937
US

V. Phone/Fax

Practice location:
  • Phone: 559-593-3570
  • Fax: 877-894-5104
Mailing address:
  • Phone: 559-593-3570
  • Fax: 877-894-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SILVA SHEKLANIAN
Title or Position: OWNER
Credential: LMFT
Phone: 559-593-3570