Provider Demographics
NPI:1891489555
Name:RENEW AND TRANSCEND WELLNESS
Entity Type:Organization
Organization Name:RENEW AND TRANSCEND WELLNESS
Other - Org Name:RENEW & TRANSCEND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DBH, LPC
Authorized Official - Phone:480-490-7837
Mailing Address - Street 1:14630 N 32ND LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4704
Mailing Address - Country:US
Mailing Address - Phone:480-490-7837
Mailing Address - Fax:
Practice Address - Street 1:1137 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1747
Practice Address - Country:US
Practice Address - Phone:602-654-3516
Practice Address - Fax:602-456-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare