Provider Demographics
NPI:1063888626
Name:RENNEKER, DEBORAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:RENNEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 ESE LOOP323 STE 635
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-0430
Mailing Address - Country:US
Mailing Address - Phone:903-952-8737
Mailing Address - Fax:903-787-5048
Practice Address - Street 1:909 ESE LOOP323 STE 635
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-0430
Practice Address - Country:US
Practice Address - Phone:903-952-8737
Practice Address - Fax:903-787-5048
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58072104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker