| Renewal Therapy Of Wy, Llc | |
|
201 W Lakeway Rd Ste 902 Gillette WY 82718-6345 | |
| (307) 209-4649 | |
| (307) 381-0493 |
| Full Name | Renewal Therapy Of Wy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 W Lakeway Rd Ste 902, Gillette, Wyoming |
| Authorized Official Name and Position | Bradley Robert Hudson (OWNER) |
| Authorized Official Contact | 3072094649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewal Therapy Of Wy, Llc 201 W Lakeway Rd Ste 902 Gillette WY 82718-6345 Ph: (307) 209-4649 | Renewal Therapy Of Wy, Llc 201 W Lakeway Rd Ste 902 Gillette WY 82718-6345 Ph: (307) 209-4649 |
| NPI Number | 1720857030 |
|---|---|
| Provider Enumeration Date | 12/28/2023 |
| Last Update Date | 12/28/2023 |
| Certification Date | 12/28/2023 |
| Medicare PECOS PAC ID | 5496198137 |
|---|---|
| Medicare Enrollment ID | O20240208004535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720857030 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Bradley Robert Hudson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1063922920 PECOS PAC ID: 6305289042 Enrollment ID: I20240208004563 |
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