Provider Demographics
NPI:1457965212
Name:RENNER, MARIEKE (LMHC)
Entity type:Individual
Prefix:
First Name:MARIEKE
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARIEKE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5514 SE MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9065
Mailing Address - Country:US
Mailing Address - Phone:360-936-9090
Mailing Address - Fax:
Practice Address - Street 1:1498 SE TECH CENTER PL STE 180
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5518
Practice Address - Country:US
Practice Address - Phone:360-619-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61344864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60975106OtherSTATE LICENSE