Provider Demographics
NPI:1508503442
Name:RENERT, OWEN RILEY
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:RILEY
Last Name:RENERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ONG
Other - Last Name:RENERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-1734
Mailing Address - Country:US
Mailing Address - Phone:805-363-0997
Mailing Address - Fax:
Practice Address - Street 1:37 MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-1734
Practice Address - Country:US
Practice Address - Phone:805-363-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health