Provider Demographics
NPI:1760617138
Name:RENEW COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:RENEW COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:319-464-2940
Mailing Address - Street 1:3356 KIMBALL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5700
Mailing Address - Country:US
Mailing Address - Phone:319-464-2940
Mailing Address - Fax:
Practice Address - Street 1:3356 KIMBALL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5700
Practice Address - Country:US
Practice Address - Phone:319-464-2940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty