Provider Demographics
NPI:1912388554
Name:RENEWED HOPE COUNSELING & WELLNESS
Entity Type:Organization
Organization Name:RENEWED HOPE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-288-4200
Mailing Address - Street 1:1550 N CRESTMONT DR STE E
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2177
Mailing Address - Country:US
Mailing Address - Phone:208-288-4200
Mailing Address - Fax:208-288-4279
Practice Address - Street 1:1550 N CRESTMONT DR STE E
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2177
Practice Address - Country:US
Practice Address - Phone:208-288-4200
Practice Address - Fax:208-288-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5837251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-5837OtherLPC