Healthcare Provider Details

I. General information

NPI: 1548798895
Provider Name (Legal Business Name): RENEWED COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E ASH ST STE B
MASON MI
48854-1792
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-1304
US

V. Phone/Fax

Practice location:
  • Phone: 517-308-9769
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH HOUPT
Title or Position: OWNER
Credential:
Phone: 517-676-9788