Individual
MR. MARK J. RENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS. LMHP, CPC, LIMHP
Contact information
Practice address
748 N MAIN ST, FREMONT, NE 68025-5004
(402) 941-7016
(402) 941-7018
Mailing address
748 N MAIN ST, FREMONT, NE 68025-5004
(402) 941-7016
(402) 941-7018
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1320
NE
101Y00000X
Counselor
2401
NE
101YA0400X
Addiction (Substance Use Disorder) Counselor
677
NE
101YM0800X
Mental Health Counselor
Primary
677
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025122100
—
NE
01
—
10025816100
MEDICAID SA
NE
Enumeration date
10/24/2006
Last updated
04/20/2011
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