MEDICARE: DR. GUY J RENFRO PH.D.

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	103TC0700X	Clinical Psychologist	329	AL

General Provider Information

NPI Number	:	1629130570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUY J RENFRO PH.D.

Provider Business Mailing Address
First Line	:	8326 CROSSLAND LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8482
Country	:	US
Telephone Number	:	334-549-3778
Fax Number	:	334-409-9370

Provider Business Practice Location Address
First Line	:	8326 CROSSLAND LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8482
Country	:	US
Telephone Number	:	334-549-3778
Fax Number	:	334-409-9370

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	10/17/2011

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