Provider Demographics
NPI:1043704760
Name:RENTZEL, LORI BETH (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:RENTZEL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROUND WALK CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1597
Mailing Address - Country:US
Mailing Address - Phone:707-338-3543
Mailing Address - Fax:
Practice Address - Street 1:411 CHINN ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4338
Practice Address - Country:US
Practice Address - Phone:707-338-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist