Provider Demographics
NPI:1629622212
Name:RENEW COUNSELING LLC
Entity Type:Organization
Organization Name:RENEW COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LSW
Authorized Official - Phone:219-608-8357
Mailing Address - Street 1:100 ANCHOR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2802
Mailing Address - Country:US
Mailing Address - Phone:574-298-0548
Mailing Address - Fax:
Practice Address - Street 1:100 ANCHOR RD STE 2
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2802
Practice Address - Country:US
Practice Address - Phone:219-608-8357
Practice Address - Fax:833-249-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1659343911Medicaid
IN1013186782Medicaid
IN1194855163Medicaid