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General NPI Number Information
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NPI Number | 1689474678
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Entity Type | Individual
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Provider Name | RENEE KAUCNIK THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | PO BOX 1100
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City | GUALALA
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State | CA
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Zip | 95445-1100
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Country | US
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Telephone | 707-884-4005
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Fax | 707-884-9728
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Provider Business Mailing Address
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Address Line | 14950 RIDGEVIEW RD
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City | WILLITS
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State | CA
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Zip | 95490-8736
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Country | US
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Telephone | 847-401-4023
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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 |
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License Number State |
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