Provider Demographics
NPI:1134252836
Name:HEROLD, RENEA LYNN
Entity type:Individual
Prefix:MRS
First Name:RENEA
Middle Name:LYNN
Last Name:HEROLD
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 1:6612 W BROOKHART WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7402
Mailing Address - Country:US
Mailing Address - Phone:623-388-6986
Mailing Address - Fax:
Practice Address - Street 1:22833 N 71ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5201
Practice Address - Country:US
Practice Address - Phone:623-376-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool