MEDICARE: ALYSSA MARIE RENVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CO

General Provider Information

NPI Number	:	1194676577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIE RENVILLE

Provider Business Mailing Address
First Line	:	3460 POST OAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 POST OAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4422
Country	:	US
Telephone Number	:	719-300-9132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ ALYSSA MARIE RENVILLE ” Practice Location

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