Provider Demographics
NPI:1578789582
Name:RENAUD, CECILIA ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:ANN
Last Name:RENAUD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CEIL
Other - Middle Name:ANN
Other - Last Name:RENAUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:128 ENCHANTED PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5497
Mailing Address - Country:US
Mailing Address - Phone:314-749-3300
Mailing Address - Fax:636-207-7316
Practice Address - Street 1:128 ENCHANTED PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5497
Practice Address - Country:US
Practice Address - Phone:314-749-3300
Practice Address - Fax:636-207-7316
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002008101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor