Provider Demographics
NPI:1467116798
Name:RENCH, JOHN MARC
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARC
Last Name:RENCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-1021
Mailing Address - Country:US
Mailing Address - Phone:765-730-3347
Mailing Address - Fax:
Practice Address - Street 1:1200 S TILLOTSON OPAS STE 4
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4846
Practice Address - Country:US
Practice Address - Phone:765-286-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000414A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)