Provider Demographics
NPI:1861370645
Name:NORMAN, RENISSA
Entity type:Individual
Prefix:DR
First Name:RENISSA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S NEW RD APT 1225
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3878
Mailing Address - Country:US
Mailing Address - Phone:913-683-1137
Mailing Address - Fax:
Practice Address - Street 1:3000 S NEW RD APT 1225
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-3878
Practice Address - Country:US
Practice Address - Phone:913-683-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling