Renewal Therapy of Wy, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RENEWAL THERAPY OF WY, LLC

Practice address

201 W Lakeway Rd Ste 902
Gillette, WY 82718-6345

Phone

(307) 209-4649

Fax

(307) 381-0493

NPI assigned

Dec 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradley Robert Hudson, LMFTNPI 1063922920

Title

Owner

Phone

(307) 209-4649

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley Robert Hudson, LMFT

  • Marriage & Family Therapist
  • Gillette, WY
  • NPI 1063922920

  WY

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1720857030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W LAKEWAY RD STE 902",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186345",
            "telephone_number": "307-209-4649",
            "fax_number": "307-381-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W LAKEWAY RD STE 902",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186345",
            "telephone_number": "307-209-4649",
            "fax_number": "307-381-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEWAL THERAPY OF WY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-28",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-209-4649",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sasha Paige Rau
• Becky Lee Reardon, PTA
• Redi Care, P.C.
• Madonna M Reece, PMHNP
• Tara Reed, M.A., NCC, LPC
• Suzette Marie Renken
• Thomas Bernard Repas, DO
• Revive Therapy
• Alisha Reynolds, OT
• Rheumatology & Osteoporosis Center of Wyoming LLC

• All providers in Gillette, WY
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.