Healthcare Provider Details

I. General information

NPI: 1336894880
Provider Name (Legal Business Name): RENEW THERAPY NW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 SW BEAVERTON HILLSDALE HWY STE 204
BEAVERTON OR
97005-3315
US

IV. Provider business mailing address

9400 SW BEAVERTON HILLSDALE HWY STE 250
BEAVERTON OR
97005-3300
US

V. Phone/Fax

Practice location:
  • Phone: 503-446-2024
  • Fax:
Mailing address:
  • Phone: 503-446-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN JIM
Title or Position: OWNER
Credential: LPC
Phone: 503-446-2024