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General NPI Number Information
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NPI Number | 1174274310
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Entity Type | Organization
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Legal Business Name | RENEWAL THERAPY, LLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 108 N. 11TH ST.
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City | SALINA
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State | KS
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Zip | 67401-2507
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Country | US
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Telephone | 785-829-1671
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Fax | 785-588-4106
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Provider Business Mailing Address
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Address Line | 1716 S. HOLMES RD.
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City | SALINA
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State | KS
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Zip | 67401-9015
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Country | US
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Telephone | 785-829-1671
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Fax | 785-588-4106
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Authorized Official
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Title or Position | CHAIRPERSON
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Name | LYDIA LUND
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Credential | LSCSW
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Telephone | 785-829-1671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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