Organization
MIND RENEWAL PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY HOWARD (OWNER)
(414) 301-3145
Entity
Organization
Contact information
Practice address
6650 W STATE ST UNIT D143, WAUWATOSA, WI 53213-2827
(414) 301-3145
(414) 296-0093
Mailing address
5464 N PORT WASHINGTON RD # C104, MILWAUKEE, WI 53217-4925
(414) 301-3145
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
11/11/2024
Last updated
04/29/2025
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