Provider Demographics
NPI:1457673923
Name:PEGGY RENNER PHD INC.
Entity Type:Organization
Organization Name:PEGGY RENNER PHD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-478-8400
Mailing Address - Street 1:2560 MONTESSOURI ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3061
Mailing Address - Country:US
Mailing Address - Phone:702-478-8400
Mailing Address - Fax:702-478-8500
Practice Address - Street 1:2560 MONTESSOURI ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3061
Practice Address - Country:US
Practice Address - Phone:702-478-8400
Practice Address - Fax:702-478-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0517251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health