MEDICARE: MRS. JULIEANNA GENOUN RENNER MFT

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	106H00000X	Marriage & Family Therapist	40913	CA

General Provider Information

NPI Number	:	1942442751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIEANNA GENOUN RENNER MFT

Provider Business Mailing Address
First Line	:	439 GRAND AVE
Second Line	:	#195
City	:	BIGFORK
State	:	MT
Zip	:	59911-3614
Country	:	US
Telephone Number	:	406-270-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 GRAND AVE
Second Line	:	#195
City	:	BIGFORK
State	:	MT
Zip	:	59911-3614
Country	:	US
Telephone Number	:	406-837-0399
Fax Number	:

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

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	03/26/2009

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