Provider Demographics
NPI:1942442751
Name:RENNER, JULIEANNA GENOUN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JULIEANNA
Middle Name:GENOUN
Last Name:RENNER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 GRAND AVE
Mailing Address - Street 2:#195
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-3614
Mailing Address - Country:US
Mailing Address - Phone:406-270-6516
Mailing Address - Fax:
Practice Address - Street 1:439 GRAND AVE
Practice Address - Street 2:#195
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3614
Practice Address - Country:US
Practice Address - Phone:406-837-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40913106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist