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General NPI Number Information
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NPI Number | 1942813373
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Entity Type | Organization
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Legal Business Name | RENEW MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 1500 MCANDREWS RD W STE 124
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 651-328-9831
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Fax | 612-416-8143
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Provider Business Mailing Address
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Address Line | 13914 AQUILA CIR
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City | SAVAGE
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State | MN
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Zip | 55378-2155
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Country | US
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Telephone | 651-328-9831
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | EMILY MARIE AXEN
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Credential | MN LICSW #24563
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Telephone | 651-328-9831
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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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