Provider Demographics
NPI:1255572707
Name:BECNEL, RENEE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:BECNEL
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 1:3401 KOSO ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6036
Mailing Address - Country:US
Mailing Address - Phone:530-351-8665
Mailing Address - Fax:
Practice Address - Street 1:105 E ST
Practice Address - Street 2:STE 2 H
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4697
Practice Address - Country:US
Practice Address - Phone:530-351-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44546103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst