Healthcare Provider Details

I. General information

NPI: 1497896849
Provider Name (Legal Business Name): MICHAEL S RENN MA MASTER OF ARTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 O STREET
LINCOLN NE
68510
US

IV. Provider business mailing address

2444 O STREET
LINCOLN NE
68510
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-7666
  • Fax: 402-476-9623
Mailing address:
  • Phone: 402-475-7666
  • Fax: 402-476-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2500
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1359
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: