| Renew Behavorial Health Inc | |
|
4000 Long Beach Blvd Ste 228 Long Beach CA 90807-2617 | |
| (562) 637-3143 | |
| (562) 637-3244 |
| Full Name | Renew Behavorial Health Inc |
|---|---|
| Speciality | Counselor |
| Location | 4000 Long Beach Blvd, Long Beach, California |
| Authorized Official Name and Position | Laja I Ibraheem (MD OWNER) |
| Authorized Official Contact | 5626373143 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Behavorial Health Inc Po Box 20140 Long Beach CA 90801-3140 Ph: (562) 637-3143 | Renew Behavorial Health Inc 4000 Long Beach Blvd Ste 228 Long Beach CA 90807-2617 Ph: (562) 637-3143 |
| NPI Number | 1033137724 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9032115936 |
|---|---|
| Medicare Enrollment ID | O20061017000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033137724 | NPI | - | NPPES |
| 00A661240 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | A66124 (California) | Primary |
| Provider Name | Laja I Ibraheem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811983232 PECOS PAC ID: 9739166315 Enrollment ID: I20040701000689 |
| Provider Name | Tshekedi Galen Dennis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215015508 PECOS PAC ID: 9830254432 Enrollment ID: I20090216000052 |
| Provider Name | Joy Dane Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285018507 PECOS PAC ID: 6709133069 Enrollment ID: I20190130001556 |
| Provider Name | Karen L Patton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265785505 PECOS PAC ID: 1254798622 Enrollment ID: I20230531002012 |
| Provider Name | Young Ah Kim |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952170680 PECOS PAC ID: 5193163103 Enrollment ID: I20240409003690 |
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