# RENEW PSYCHIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Renew Psychiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447082391
- **Authorized official:** MR. THOMAS UGELSTAD PMHNP (NURSE PRACTITIONER)
- **Authorized official phone:** (701) 251-0551

## Contact information

- **Practice address:** 4656 AMBER VALLEY PKWY S, FARGO, ND 58104-4593
- **Practice address phone:** (701) 552-2325
- **Mailing address:** 2626 PACIFIC DR S APT 301, FARGO, ND 58103-5547
- **Mailing address phone:** (701) 251-0551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/19/2024
- **Last updated:** 10/13/2024