Provider Demographics
NPI:1942630983
Name:RENAULT, ANTRA (MSW)
Entity Type:Individual
Prefix:
First Name:ANTRA
Middle Name:
Last Name:RENAULT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73560 ABEENE LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9201
Mailing Address - Country:US
Mailing Address - Phone:612-327-1767
Mailing Address - Fax:
Practice Address - Street 1:175 W B ST STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4575
Practice Address - Country:US
Practice Address - Phone:541-762-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor