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NPI Code Detail

MEDICARE: MARIEKE RENNER LMHC

MEDICARE: MARIEKE RENNER LMHC
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 CounselorLH61344864WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CG60975106OTHERWASTATE LICENSE

General Provider Information

NPI Number : 1457965212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIEKE RENNER LMHC
Provider Business Mailing Address
First Line : 5514 SE MALDEN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-9065
Country : US
Telephone Number : 360-936-9090
Fax Number :
Provider Business Practice Location Address
First Line : 1498 SE TECH CENTER PL STE 180
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5518
Country : US
Telephone Number : 360-619-2226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2020
Last Update Date : 11/12/2024

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