Basic Information
| Provider Information | |||||||||
| NPI: | 1912388554 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RENEWED HOPE COUNSELING & WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 N CRESTMONT DR STE E | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836422177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884200 | ||||||||
| FaxNumber: | 2082884279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1550 N CRESTMONT DR STE E | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836422177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884200 | ||||||||
| FaxNumber: | 2082884279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | AUDRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2082884200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | LPC-5837 | ID | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | LPC-5837 | 01 | ID | LPC | OTHER |