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General NPI Number Information
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NPI Number | 1700741055
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Entity Type | Organization
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Legal Business Name | RENEWLY COUNSELING
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1660 121ST AVE NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-1917
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Country | US
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Telephone | 218-831-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 121ST AVE NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-1917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRETCHEN JANELLE RINGDAHL PHUNG
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Credential | DMFT, LMFT, IMH-E
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Telephone | 218-831-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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