Healthcare Provider Details

I. General information

NPI: 1689120024
Provider Name (Legal Business Name): RENEWAL RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 UNIVERSITY AVE
LOS ALTOS CA
94024-4637
US

IV. Provider business mailing address

858 UNIVERSITY AVE
LOS ALTOS CA
94024-4637
US

V. Phone/Fax

Practice location:
  • Phone: 408-420-7895
  • Fax:
Mailing address:
  • Phone: 408-420-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTHA THORSON
Title or Position: DIRECTOR
Credential: LMFT
Phone: 408-420-7895