Provider Demographics
NPI:1508079096
Name:SMITH, RENNIE M (LICENSED MARRIAGE FA)
Entity Type:Individual
Prefix:MRS
First Name:RENNIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PRESLEY WAY SUITE 10
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-913-8933
Mailing Address - Fax:
Practice Address - Street 1:113 PRESLEY WAY SUITE 10
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-913-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist