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General NPI Number Information
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NPI Number | 1467026401
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Entity Type | Organization
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Legal Business Name | RENEWAL COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 1301 PYOTT RD STE 208A
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-9798
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Country | US
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Telephone | 224-326-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 808 E OAK STREET UNIT 1A
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-3365
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Country | US
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Telephone | 224-326-4200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE WALL
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Credential | LCPC, CADC
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Telephone | 224-326-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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