Provider Demographics
NPI:1518047174
Name:RENSHAW, KAYE LYNN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:KAYE
Middle Name:LYNN
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7480 GOLDEN POND PL STE 400
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1966
Mailing Address - Country:US
Mailing Address - Phone:806-282-4901
Mailing Address - Fax:806-354-9991
Practice Address - Street 1:7480 GOLDEN POND PL
Practice Address - Street 2:SUITE 400
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1962
Practice Address - Country:US
Practice Address - Phone:806-354-9997
Practice Address - Fax:806-354-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX270944OtherVALUE OPTIONS
TX82624LOtherBC/BS
TX216750000OtherMAGELLAN BEHAVIORAL HEALT
TX23426761OtherDFPS
TXSN05013OtherTEXAS YOUTH COMMISSION
TX026428501Medicaid