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General NPI Number Information
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NPI Number | 1336376748
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Entity Type | Organization
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Legal Business Name | MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 825 ZION ST
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City | NEVADA CITY
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State | CA
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Zip | 95959-2922
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Country | US
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Telephone | 530-265-2199
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Fax | 530-265-2619
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Provider Business Mailing Address
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Address Line | 825 ZION ST
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City | NEVADA CITY
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State | CA
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Zip | 95959-2922
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Country | US
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Telephone | 530-265-2199
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Fax | 530-265-2619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCIA J RENNIE
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Credential | PHD
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Telephone | 530-265-2199
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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 | 22214
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License Number State | CA
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