MEDICARE: CAROLE J RENNER LMHC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962440065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE J RENNER LMHC

Provider Business Mailing Address
First Line	:	2194 HIGHWAY A1A
Second Line	:	STE 203
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-8930
Fax Number	:	321-773-5479

Provider Business Practice Location Address
First Line	:	2194 HIGHWAY A1A
Second Line	:	STE 203
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-4930
Country	:	US
Telephone Number	:	321-777-8930
Fax Number	:	321-773-5479

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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