Provider Demographics
NPI:1851474290
Name:GERENZ, THOMAS S (LACD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:GERENZ
Suffix:
Gender:M
Credentials:LACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 9TH ST E
Mailing Address - Street 2:APT. 2314
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-4700
Mailing Address - Country:US
Mailing Address - Phone:651-330-0506
Mailing Address - Fax:
Practice Address - Street 1:1351 FROST AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-4442
Practice Address - Country:US
Practice Address - Phone:651-773-0473
Practice Address - Fax:651-773-9298
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300284101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)