Provider Demographics
NPI:1326165630
Name:MINNESOTA RENEWAL CENTER
Entity Type:Organization
Organization Name:MINNESOTA RENEWAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:651-486-4828
Mailing Address - Street 1:3499 LEXINGTON AVE. N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-7058
Mailing Address - Country:US
Mailing Address - Phone:651-486-4828
Mailing Address - Fax:651-482-9119
Practice Address - Street 1:3499 LEXINGTON AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-7058
Practice Address - Country:US
Practice Address - Phone:651-486-4828
Practice Address - Fax:651-482-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty