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General NPI Number Information
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NPI Number | 1255476826
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Entity Type | Individual
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Provider Name | RENAEE CLITES PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3130 N COUNTY ROAD 25A
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City | TROY
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State | OH
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Zip | 45373-1337
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Country | US
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Telephone | 937-440-7021
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Fax | 937-440-7076
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Provider Business Mailing Address
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Address Line | 3130 N COUNTY ROAD 25A PO BOX 637
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City | TROY
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State | OH
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Zip | 45373-1337
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Country | US
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Telephone | 937-440-7021
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Fax | 937-440-7076
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6144
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License Number State | OH
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