Provider Demographics
NPI:1629130570
Name:RENFRO, GUY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:J
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 1:8326 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8482
Mailing Address - Country:US
Mailing Address - Phone:334-549-3778
Mailing Address - Fax:334-409-9370
Practice Address - Street 1:8326 CROSSLAND LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8482
Practice Address - Country:US
Practice Address - Phone:334-549-3778
Practice Address - Fax:334-409-9370
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR35723Medicare UPIN
AL000070662Medicare ID - Type Unspecified