Provider Demographics
NPI:1619162930
Name:RENNEWANZ-REEVES, KANDISE N (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:KANDISE
Middle Name:N
Last Name:RENNEWANZ-REEVES
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 AMETHYST DR
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-8813
Mailing Address - Country:US
Mailing Address - Phone:970-812-3780
Mailing Address - Fax:
Practice Address - Street 1:700 BELFORD AVE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3171
Practice Address - Country:US
Practice Address - Phone:970-812-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000344101YA0400X
COLPC.0012066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)