Provider Demographics
NPI:1689402653
Name:RENEW FAMILY THERAPY, INC
Entity type:Organization
Organization Name:RENEW FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:HOUSTON-CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-541-5154
Mailing Address - Street 1:1275 W MAIN ST UNIT 703
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-1528
Mailing Address - Country:US
Mailing Address - Phone:909-264-8566
Mailing Address - Fax:
Practice Address - Street 1:2558 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8445
Practice Address - Country:US
Practice Address - Phone:209-541-5154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)