Healthcare Provider Details

I. General information

NPI: 1700435880
Provider Name (Legal Business Name): LAVONNE RENNO LPCC8744
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 05/30/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13150 MUGU CT
APPLE VALLEY CA
92308-3714
US

IV. Provider business mailing address

13150 MUGU CT
APPLE VALLEY CA
92308-3714
US

V. Phone/Fax

Practice location:
  • Phone: 760-964-7354
  • Fax:
Mailing address:
  • Phone: 760-964-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: