Healthcare Provider Details

I. General information

NPI: 1700741055
Provider Name (Legal Business Name): RENEWLY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 121ST AVE NW
COON RAPIDS MN
55448-1917
US

IV. Provider business mailing address

1660 121ST AVE NW
COON RAPIDS MN
55448-1917
US

V. Phone/Fax

Practice location:
  • Phone: 218-831-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DR. GRETCHEN JANELLE RINGDAHL PHUNG
Title or Position: OWNER
Credential: DMFT, LMFT, IMH-E
Phone: 218-831-0552