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NPI Code Detail

MEDICARE: MS. LISA R. RENDA MA, LMFT

MEDICARE: MS. LISA R. RENDA MA, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor11127012-3902UT
2101YP2500XProfessional CounselorRC00012185WA

General Provider Information

NPI Number : 1417264268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA R. RENDA MA, LMFT
Provider Business Mailing Address
First Line : 325 E ZION TRL N
Second Line :
City : TOQUERVILLE
State : UT
Zip : 84774-5121
Country : US
Telephone Number : 253-304-4187
Fax Number :
Provider Business Practice Location Address
First Line : 1664 S DIXIE DR STE E102
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84770-7329
Country : US
Telephone Number : 253-304-4187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2010
Last Update Date : 09/01/2021

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