| Renewal Therapy Services Llc | |
|
3030 Lake Ave Ste 23 Fort Wayne IN 46805-5428 | |
| (260) 267-5631 | |
| Not Available |
| Full Name | Renewal Therapy Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 3030 Lake Ave Ste 23, Fort Wayne, Indiana |
| Authorized Official Name and Position | Vanessa Jones (OWNER) |
| Authorized Official Contact | 2602675631 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewal Therapy Services Llc 3030 Lake Ave Ste 23 Fort Wayne IN 46805-5428 Ph: (260) 267-5631 | Renewal Therapy Services Llc 3030 Lake Ave Ste 23 Fort Wayne IN 46805-5428 Ph: (260) 267-5631 |
| NPI Number | 1699503136 |
|---|---|
| Provider Enumeration Date | 07/25/2024 |
| Last Update Date | 07/25/2024 |
| Certification Date | 07/25/2024 |
| Medicare PECOS PAC ID | 0749712156 |
|---|---|
| Medicare Enrollment ID | O20241010000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699503136 | NPI | - | NPPES |
| Provider Name | Vanessa L Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144664574 PECOS PAC ID: 1759734478 Enrollment ID: I20240130001401 |
| Provider Name | Jacqueline Brandy Vedder |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1881148666 PECOS PAC ID: 4385176791 Enrollment ID: I20241024000329 |
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