MEDICARE: RENOVA WELLNESS AND CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1033905518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENOVA WELLNESS AND CONSULTING PLLC

Provider Business Mailing Address
First Line	:	10061 S 4400 W
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-9193
Country	:	US
Telephone Number	:	801-317-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 W 12600 S STE B
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7172
Country	:	US
Telephone Number	:	801-317-8522
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JOSEPH GLEED
Credential	:	LCSW
Telephone Number	:	801-317-8522

Provider Enumeration Date	:	04/19/2025
Last Update Date	:	01/19/2026

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