Provider Demographics
NPI:1629238365
Name:RENBARGER, JONI D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONI
Middle Name:D
Last Name:RENBARGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:SPROUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:368 COURTHOUSE RD STE D
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1854
Mailing Address - Country:US
Mailing Address - Phone:228-380-1292
Mailing Address - Fax:
Practice Address - Street 1:368 COURTHOUSE RD STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1854
Practice Address - Country:US
Practice Address - Phone:228-380-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical