Provider Demographics
NPI:1215187075
Name:RENTZ, DONALD KEVIN (MED, EDS, NCSP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KEVIN
Last Name:RENTZ
Suffix:
Gender:M
Credentials:MED, EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 MOUNTAIN WAY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6902
Mailing Address - Country:US
Mailing Address - Phone:307-472-3925
Mailing Address - Fax:
Practice Address - Street 1:5423 MOUNTAIN WAY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6902
Practice Address - Country:US
Practice Address - Phone:307-472-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCCSP03103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool