Provider Demographics
NPI:1831583269
Name:PODRAZA, RENEE (MA, LPC, LISAC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PODRAZA
Suffix:
Gender:F
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 MILLER VALLEY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1821
Mailing Address - Country:US
Mailing Address - Phone:928-830-9651
Mailing Address - Fax:
Practice Address - Street 1:843 MILLER VALLEY RD STE 203
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1821
Practice Address - Country:US
Practice Address - Phone:928-830-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10354101YA0400X
AZ12274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)