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General NPI Number Information
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NPI Number | 1457965212
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Entity Type | Individual
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Provider Name | MARIEKE RENNER LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL STE 180
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City | VANCOUVER
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State | WA
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Zip | 98683-5518
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Country | US
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Telephone | 360-619-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 5514 SE MALDEN ST
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City | PORTLAND
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State | OR
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Zip | 97206-9065
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Country | US
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Telephone | 360-936-9090
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61344864
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License Number State | WA
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