Provider Demographics
NPI:1770195315
Name:RENEWED HOPE FOR MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:RENEWED HOPE FOR MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/CERTIFIED PEER SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:636-344-6572
Mailing Address - Street 1:312 PLEASANT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-2672
Mailing Address - Country:US
Mailing Address - Phone:314-363-1921
Mailing Address - Fax:
Practice Address - Street 1:5 W PEARCE BLVD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1415
Practice Address - Country:US
Practice Address - Phone:636-344-6572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty