Healthcare Provider Details

I. General information

NPI: 1407881865
Provider Name (Legal Business Name): ANDREW G. RENOUF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HUBBARD LN SUITE 6
EUREKA CA
95501-4802
US

IV. Provider business mailing address

3015 HUBBARD LN SUITE 6
EUREKA CA
95501-4802
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-7011
  • Fax: 707-444-2757
Mailing address:
  • Phone: 707-269-7011
  • Fax: 707-444-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15843
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY15843
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY15843
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: