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General NPI Number Information
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NPI Number | 1952721540
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Entity Type | Organization
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Legal Business Name | RENOVO COUNSELING
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 510 W 40TH ST
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City | MARION
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State | IN
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Zip | 46953-4946
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Country | US
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Telephone | 765-398-3879
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Fax | 765-677-9240
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Provider Business Mailing Address
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Address Line | 510 W 40TH ST
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City | MARION
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State | IN
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Zip | 46953-4946
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Country | US
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Telephone | 765-398-3879
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Fax | 765-677-9240
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Authorized Official
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Title or Position | CO-OWNER
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Name | GARY MARTENS
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Credential | MA, LMFT
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Telephone | 765-398-3879
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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 | 39001192A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001718A
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License Number State | IN
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