MEDICARE: RENEWNM THERAPY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	106H00000X	Marriage & Family Therapist
3	251S00000X	Community/Behavioral Health Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902585169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWNM THERAPY, INC.

Provider Business Mailing Address
First Line	:	4801 LANG AVE NE STE 110
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4475
Country	:	US
Telephone Number	:	505-207-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 RIVERSIDE PLAZA LN NW STE 210
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2682
Country	:	US
Telephone Number	:	505-207-8580
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE KEENE
Credential	:
Telephone Number	:	505-207-8580

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	10/04/2024

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