Provider Demographics
NPI:1255841854
Name:RENOLD, LOWELL CARL II (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:CARL
Last Name:RENOLD
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5294
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5294
Mailing Address - Country:US
Mailing Address - Phone:714-349-3735
Mailing Address - Fax:
Practice Address - Street 1:505 S VILLA REAL
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3445
Practice Address - Country:US
Practice Address - Phone:714-349-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health