Provider Demographics
NPI:1639668353
Name:RENTERIA, KIABETH (APCC, MS & BA, RBT)
Entity Type:Individual
Prefix:
First Name:KIABETH
Middle Name:
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:APCC, MS & BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9755 LINCOLN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3334
Mailing Address - Country:US
Mailing Address - Phone:916-363-6103
Mailing Address - Fax:
Practice Address - Street 1:414 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4000
Practice Address - Country:US
Practice Address - Phone:530-406-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-48872106S00000X
CAAPCC8941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician