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General NPI Number Information
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NPI Number | 1548746456
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS CENTER
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 2 5TH ST N STE 202
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City | GREAT FALLS
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State | MT
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Zip | 59401-4011
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Country | US
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Telephone | 406-453-9355
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Fax | 844-274-1180
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Provider Business Mailing Address
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Address Line | PO BOX 2691
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City | GREAT FALLS
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State | MT
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Zip | 59403-2691
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Country | US
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Telephone | 406-453-9355
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Fax | 844-274-1180
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Authorized Official
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Title or Position | CO-OWNER
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Name | STACY PETERSON
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Credential |
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Telephone | 406-868-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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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