| Renegade Healing Co., Llc | |
|
5711 N Vista Grande Dr Otis Orchards WA 99027-9103 | |
| (253) 617-8857 | |
| Not Available |
| Full Name | Renegade Healing Co., Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5711 N Vista Grande Dr, Otis Orchards, Washington |
| Authorized Official Name and Position | Bradley Kubat (OWNER/CLINICIAN) |
| Authorized Official Contact | 2536178857 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renegade Healing Co., Llc 5711 N Vista Grande Dr Otis Orchards WA 99027-9103 Ph: () - | Renegade Healing Co., Llc 5711 N Vista Grande Dr Otis Orchards WA 99027-9103 Ph: (253) 617-8857 |
| NPI Number | 1780540864 |
|---|---|
| Provider Enumeration Date | 01/01/2026 |
| Last Update Date | 01/01/2026 |
| Certification Date | 01/01/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780540864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |