MEDICARE: KATHERINE RENKEN

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1477884955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE RENKEN

Provider Business Mailing Address
First Line	:	7100 MERCURIO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 W CRAIG RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5115
Country	:	US
Telephone Number	:	702-750-0377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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Directions to “ KATHERINE RENKEN ” Practice Location

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