Provider Demographics
NPI:1336894880
Name:RENEW THERAPY NW
Entity type:Organization
Organization Name:RENEW THERAPY NW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JIM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-446-2024
Mailing Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3300
Mailing Address - Country:US
Mailing Address - Phone:503-446-2024
Mailing Address - Fax:
Practice Address - Street 1:9400 SW BEAVERTON HILLSDALE HWY STE 204
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3315
Practice Address - Country:US
Practice Address - Phone:503-446-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1144535162Medicaid