Provider Demographics
NPI:1033905518
Name:RENOVA WELLNESS & CONSULTING, PLLC
Entity type:Organization
Organization Name:RENOVA WELLNESS & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CCPT
Authorized Official - Phone:801-317-8522
Mailing Address - Street 1:10061 S 4400 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-9193
Mailing Address - Country:US
Mailing Address - Phone:801-616-2116
Mailing Address - Fax:
Practice Address - Street 1:10694 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3525
Practice Address - Country:US
Practice Address - Phone:801-317-8522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health