Provider Demographics
NPI:1609260629
Name:RENFRO, AMY
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:RENFRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 TERMINAL WAY
Mailing Address - Street 2:STE 5
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3445
Mailing Address - Country:US
Mailing Address - Phone:775-336-2813
Mailing Address - Fax:775-336-2813
Practice Address - Street 1:1465 TERMINAL WAY
Practice Address - Street 2:STE 5
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3445
Practice Address - Country:US
Practice Address - Phone:775-336-2813
Practice Address - Fax:775-336-2813
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst