Provider Demographics
NPI:1417264268
Name:RENDA, LISA R (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:RENDA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E ZION TRL N
Mailing Address - Street 2:
Mailing Address - City:TOQUERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84774-5121
Mailing Address - Country:US
Mailing Address - Phone:253-304-4187
Mailing Address - Fax:
Practice Address - Street 1:1664 S DIXIE DR STE E102
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:253-304-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11127012-3902101YM0800X
WARC00012185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health