Provider Demographics
NPI:1700435880
Name:RENNO, LAVONNE (LPCC8744)
Entity Type:Individual
Prefix:MS
First Name:LAVONNE
Middle Name:
Last Name:RENNO
Suffix:
Gender:F
Credentials:LPCC8744
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11248 WILSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-4737
Mailing Address - Country:US
Mailing Address - Phone:760-964-7354
Mailing Address - Fax:
Practice Address - Street 1:18484 HIGHWAY18 #125
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-9230
Practice Address - Country:US
Practice Address - Phone:760-964-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional