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RENEGADE HEALING CO., LLC
NPI 1780540864
Counselor - Mental Health in Otis Orchards, WA

Active since January 01, 2026
5711 N VISTA GRANDE DR, OTIS ORCHARDS, WA 99027(253) 617-8857 Get Directions Write a Review

NPPES record last updated: January 1, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Renegade Healing Co., Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RENEGADE HEALING CO., LLC (NPI 1780540864) is a healthcare organization registered as a mental health in Otis Orchards, Washington and active in the NPI registry since January 2026. The organization lists Bradley Kubat, Owner/clinician, as its authorized official.

NPPES Registry Identity

NPI1780540864
Entity TypeOrganization
Primary Taxonomy101YM0800X
Legal Business NameRENEGADE HEALING CO., LLC
Location Address5711 N VISTA GRANDE DROtis Orchards, WA 99027-9103
Mailing Address5711 N Vista Grande DrOtis Orchards, WA 99027-9103
Phone(253) 617-8857
Organization SubpartNo
Authorized OfficialBradley KubatOwner/clinician · (253) 617-8857
Enumeration DateJanuary 1, 2026
NPPES CertifiedJanuary 1, 2026
✔ NPI 1780540864 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
5711 N VISTA GRANDE DR, Otis Orchards, WA 99027
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Renegade Healing Co., LLC's NPI number?

The NPI number for Renegade Healing Co., LLC is 1780540864. It was assigned to this organization in the NPPES registry on January 1, 2026.

Where is Renegade Healing Co., LLC located?

Renegade Healing Co., LLC is located at 5711 N Vista Grande Dr, Otis Orchards, WA 99027. The listed phone number is (253) 617-8857.

What is Renegade Healing Co., LLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Renegade Healing Co., LLC was last updated on January 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.