Provider Demographics
NPI:1336376748
Name:MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP
Entity Type:Organization
Organization Name:MARCIA JELLA' RENNIE, PHD, A PSYCHOLOGICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-265-2199
Mailing Address - Street 1:825 ZION ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2922
Mailing Address - Country:US
Mailing Address - Phone:530-265-2199
Mailing Address - Fax:530-265-2619
Practice Address - Street 1:825 ZION ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2922
Practice Address - Country:US
Practice Address - Phone:530-265-2199
Practice Address - Fax:530-265-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22214103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty