Provider Demographics
NPI:1275213811
Name:RENEW MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:RENEW MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAWNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:712-310-3920
Mailing Address - Street 1:10 WAUBONSIE AVE
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:IA
Mailing Address - Zip Code:51653-2032
Mailing Address - Country:US
Mailing Address - Phone:712-310-3920
Mailing Address - Fax:
Practice Address - Street 1:411 ORANGE ST
Practice Address - Street 2:
Practice Address - City:TABOR
Practice Address - State:IA
Practice Address - Zip Code:51653-2049
Practice Address - Country:US
Practice Address - Phone:319-804-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)