Provider Demographics
NPI:1013540178
Name:RENOVATION COUNSELING, PLLC
Entity Type:Organization
Organization Name:RENOVATION COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-280-7486
Mailing Address - Street 1:620 CIVIC HEIGHTS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-4709
Mailing Address - Country:US
Mailing Address - Phone:763-280-7486
Mailing Address - Fax:
Practice Address - Street 1:620 CIVIC HEIGHTS DR STE 103
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-4709
Practice Address - Country:US
Practice Address - Phone:763-280-7486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty