| Renewal Therapy, Llc | |
|
108 N. 11th St. Salina KS 67401-2507 | |
| (785) 829-1671 | |
| (785) 588-4106 |
| Full Name | Renewal Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 108 N. 11th St., Salina, Kansas |
| Authorized Official Name and Position | Lydia Lund (CHAIRPERSON) |
| Authorized Official Contact | 7858291671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewal Therapy, Llc 1716 S. Holmes Rd. Salina KS 67401-9015 Ph: (785) 829-1671 | Renewal Therapy, Llc 108 N. 11th St. Salina KS 67401-2507 Ph: (785) 829-1671 |
| NPI Number | 1174274310 |
|---|---|
| Provider Enumeration Date | 01/10/2022 |
| Last Update Date | 01/10/2022 |
| Certification Date | 01/10/2022 |
| Medicare PECOS PAC ID | 6305231986 |
|---|---|
| Medicare Enrollment ID | O20220317001028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174274310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lydia M Lund |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467813337 PECOS PAC ID: 0749605939 Enrollment ID: I20200805001060 |
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