Healthcare Provider Details

I. General information

NPI: 1669398996
Provider Name (Legal Business Name): MICHELLE CORDERO RENTERIA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721A SPRUCE ST SW
MCCHORD AFB WA
98439-1419
US

IV. Provider business mailing address

4721A SPRUCE ST SW
MCCHORD AFB WA
98439-1419
US

V. Phone/Fax

Practice location:
  • Phone: 210-288-7691
  • Fax:
Mailing address:
  • Phone: 210-288-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: