Provider Demographics
NPI:1184389512
Name:RENEWAL COUNSELING SERVICES
Entity type:Organization
Organization Name:RENEWAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ANEES
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-515-9719
Mailing Address - Street 1:7515 CHAROLAIS DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1208
Mailing Address - Country:US
Mailing Address - Phone:408-515-9719
Mailing Address - Fax:
Practice Address - Street 1:7515 CHAROLAIS DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1208
Practice Address - Country:US
Practice Address - Phone:408-515-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)