Provider Demographics
NPI:1194816744
Name:RENFROE, LINDA (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RENFROE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 VIA SANTA MARIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9419
Mailing Address - Country:US
Mailing Address - Phone:949-388-5404
Mailing Address - Fax:
Practice Address - Street 1:3551 CAMINO MIRA COSTA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3508
Practice Address - Country:US
Practice Address - Phone:949-234-1120
Practice Address - Fax:949-234-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 35635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist