Provider Demographics
NPI:1598005316
Name:RENFRO, RICHARD L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:RENFRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146723
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8551
Mailing Address - Country:US
Mailing Address - Phone:773-750-4902
Mailing Address - Fax:
Practice Address - Street 1:6439 N SHERIDAN RD STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5364
Practice Address - Country:US
Practice Address - Phone:773-508-3361
Practice Address - Fax:773-508-3415
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical