MEDICARE: RENEWAL RIVER COUNSELING, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518818665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWAL RIVER COUNSELING, LLC

Provider Business Mailing Address
First Line	:	6545 MARKET AVE N STE 100
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-919-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 MARKET AVE N STE 100
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-919-4488
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE N GARY
Credential	:	LPCC
Telephone Number	:	330-919-4488

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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