Provider Demographics
NPI:1346386976
Name:ANN M. RENARD, PHD LP PC
Entity Type:Organization
Organization Name:ANN M. RENARD, PHD LP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RENARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:248-414-4050
Mailing Address - Street 1:2011 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4049
Mailing Address - Country:US
Mailing Address - Phone:248-414-4050
Mailing Address - Fax:248-414-4053
Practice Address - Street 1:2011 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4049
Practice Address - Country:US
Practice Address - Phone:248-414-4050
Practice Address - Fax:248-414-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N58730Medicare ID - Type Unspecified
MIS19982Medicare UPIN