Provider Demographics
NPI:1619297678
Name:RENZ, DIANE (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RENZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 IRIS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5205
Mailing Address - Country:US
Mailing Address - Phone:720-317-5170
Mailing Address - Fax:
Practice Address - Street 1:3393 IRIS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5205
Practice Address - Country:US
Practice Address - Phone:720-317-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health