Healthcare Provider Details

I. General information

NPI: 1669340030
Provider Name (Legal Business Name): RENNER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 BLISS WAY
KISSIMMEE FL
34747
US

IV. Provider business mailing address

2705 WOLCOTT LN
KISSIMMEE FL
34747-1817
US

V. Phone/Fax

Practice location:
  • Phone: 352-363-5600
  • Fax:
Mailing address:
  • Phone: 352-363-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKAELA RENNER
Title or Position: OWNER
Credential: LMHC, LMHP
Phone: 402-677-3586