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General NPI Number Information
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NPI Number | 1124268255
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Entity Type | Individual
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Provider Name | CARL T. RENFRO III PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 221 S 2ND AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1310
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Country | US
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Telephone | 208-263-1736
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Fax |
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Provider Business Mailing Address
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Address Line | 221 S 2ND AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1310
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Country | US
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Telephone | 208-263-1736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-170
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License Number State | ID
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