Provider Demographics
NPI:1457815078
Name:MERAZ, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:MERAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14656 GINGER KERRICK
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-1018
Mailing Address - Country:US
Mailing Address - Phone:915-301-5804
Mailing Address - Fax:
Practice Address - Street 1:10921 PELLICANO DR STE 105
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4604
Practice Address - Country:US
Practice Address - Phone:915-301-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2023-08-02
Deactivation Date:2023-07-17
Deactivation Code:
Reactivation Date:2023-08-02
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX87775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician