Provider Demographics
NPI:1396504221
Name:RENOUF, KATELIN LEE ANN KELLEY
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:LEE ANN KELLEY
Last Name:RENOUF
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 1:809 17TH TER NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4427
Mailing Address - Country:US
Mailing Address - Phone:870-321-2979
Mailing Address - Fax:
Practice Address - Street 1:809 17TH TER NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4427
Practice Address - Country:US
Practice Address - Phone:870-321-2979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health