Provider Demographics
NPI:1083933501
Name:RENFRO & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RENFRO & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:504-339-4801
Mailing Address - Street 1:4132 GEORGIA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2283
Mailing Address - Country:US
Mailing Address - Phone:504-339-4801
Mailing Address - Fax:
Practice Address - Street 1:3715 WILLIAMS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3066
Practice Address - Country:US
Practice Address - Phone:504-201-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3439251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101Y00000XMedicaid