Provider Demographics
NPI:1689458952
Name:RENFRO, JASMIN JEAN (SUDRC)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:JEAN
Last Name:RENFRO
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 RICARDO AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2653
Mailing Address - Country:US
Mailing Address - Phone:530-722-1114
Mailing Address - Fax:530-722-1115
Practice Address - Street 1:3617 RICARDO AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2653
Practice Address - Country:US
Practice Address - Phone:307-221-1145
Practice Address - Fax:530-722-1115
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)