Provider Demographics
NPI:1972090793
Name:RENEW YOU WELLNESS
Entity Type:Organization
Organization Name:RENEW YOU WELLNESS
Other - Org Name:JULIE BARRETT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:559-770-8199
Mailing Address - Street 1:55 SHAW AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3819
Mailing Address - Country:US
Mailing Address - Phone:559-770-8199
Mailing Address - Fax:
Practice Address - Street 1:55 SHAW AVE STE 120
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3819
Practice Address - Country:US
Practice Address - Phone:559-770-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIE BARRETT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty