Healthcare Provider Details

I. General information

NPI: 1164361390
Provider Name (Legal Business Name): RENEW MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N CASS AVE STE 112
WESTMONT IL
60559-6401
US

IV. Provider business mailing address

825 N CASS AVE STE 112
WESTMONT IL
60559-6401
US

V. Phone/Fax

Practice location:
  • Phone: 708-303-8822
  • Fax:
Mailing address:
  • Phone: 708-303-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAMELA BULT
Title or Position: OWNER
Credential: LCSW
Phone: 708-307-7291