Provider Demographics
NPI:1689609588
Name:BRANTNER, RENA JANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:JANE
Last Name:BRANTNER
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 1:1428 WEATHERLY RD SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1181
Mailing Address - Country:US
Mailing Address - Phone:256-881-0704
Mailing Address - Fax:256-883-7833
Practice Address - Street 1:1428 WEATHERLY RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-1181
Practice Address - Country:US
Practice Address - Phone:256-881-0704
Practice Address - Fax:256-883-7833
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL071724OtherVALUE OPTIONS PROV
AL1131460OtherCIGNA BEHAV HEALTH
AL210472OtherVALUE BEHAV HEALTH
AL62 28999OtherUBH PROV
ALMAGELLANOtherMIS#
AL515 01227Medicare UPIN
ALNPP 4045845Medicare UPIN
AL510 39530Medicare UPIN