Provider Demographics
NPI:1033126149
Name:RENEAU, SANDRA J (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:RENEAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4920
Mailing Address - Country:US
Mailing Address - Phone:405-794-5552
Mailing Address - Fax:405-759-2402
Practice Address - Street 1:412 N TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4920
Practice Address - Country:US
Practice Address - Phone:405-794-5552
Practice Address - Fax:405-759-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health