Provider Demographics
NPI:1629216130
Name:RENEW HOPE COUNSELING INC
Entity Type:Organization
Organization Name:RENEW HOPE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:260-463-6915
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-0292
Mailing Address - Country:US
Mailing Address - Phone:260-463-6915
Mailing Address - Fax:260-499-4158
Practice Address - Street 1:5460 N 450 W
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-8504
Practice Address - Country:US
Practice Address - Phone:260-463-6915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001635A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health