Provider Demographics
NPI:1922347111
Name:BENARD, RENEE M (LLP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:BENARD
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16402 PICARDIE WAY
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9237
Mailing Address - Country:US
Mailing Address - Phone:517-896-8097
Mailing Address - Fax:
Practice Address - Street 1:2127 UNIVERSITY PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5928
Practice Address - Country:US
Practice Address - Phone:248-453-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist