Healthcare Provider Details

I. General information

NPI: 1669304234
Provider Name (Legal Business Name): THE RENEWAL COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 SHOPPES BLVD
MOOSIC PA
18507-2147
US

IV. Provider business mailing address

797 MAIN ST
SUGAR NOTCH PA
18706-2019
US

V. Phone/Fax

Practice location:
  • Phone: 570-466-5435
  • Fax: 570-990-3029
Mailing address:
  • Phone: 570-466-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHAEL KREIDLER
Title or Position: OWNER/PROVIDER
Credential:
Phone: 570-466-5435