Healthcare Provider Details

I. General information

NPI: 1376385328
Provider Name (Legal Business Name): RENEW YOU COUNSELING AND THERAPY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAIN ST STE 654&656
PUEBLO CO
81003-3130
US

IV. Provider business mailing address

503 N MAIN ST STE 654&656
PUEBLO CO
81003-3130
US

V. Phone/Fax

Practice location:
  • Phone: 719-501-8596
  • Fax:
Mailing address:
  • Phone: 719-766-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NIKI ARRIAGA
Title or Position: PARTNER
Credential: LPC
Phone: 719-501-8596