Provider Demographics
NPI:1447592811
Name:RENEW COUNSELING LLC
Entity Type:Organization
Organization Name:RENEW COUNSELING LLC
Other - Org Name:RENEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:801-971-2075
Mailing Address - Street 1:63 E 11400 S
Mailing Address - Street 2:#103
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6705
Mailing Address - Country:US
Mailing Address - Phone:801-971-2075
Mailing Address - Fax:
Practice Address - Street 1:63 E 11400 S
Practice Address - Street 2:#103
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-6705
Practice Address - Country:US
Practice Address - Phone:801-971-2075
Practice Address - Fax:801-943-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4780650-6004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health