Basic Information
| Provider Information | |||||||||
| NPI: | 1922347111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENARD | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16402 PICARDIE WAY | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488239237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178968097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2127 UNIVERSITY PARK DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488645928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484537525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2013 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6361000220 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.