=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316553712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEW COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2020
-----------------------------------------------------
Last Update Date | 09/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 418 2ND AVE NE
-----------------------------------------------------
City | SIOUX CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51250-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-600-4717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 418 2ND AVE NE
-----------------------------------------------------
City | SIOUX CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51250-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-600-4717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER/OWNER
-----------------------------------------------------
Name | STEPHANIE ADAMS
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 808-203-7769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------