Provider Demographics
NPI:1114581196
Name:RENUCCI, ROBIN WAGNER (MED, EDS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:WAGNER
Last Name:RENUCCI
Suffix:
Gender:F
Credentials:MED, EDS, NCC, LPC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, EDS, NCC, LP
Mailing Address - Street 1:3830 BRINKMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6311
Mailing Address - Country:US
Mailing Address - Phone:713-826-7909
Mailing Address - Fax:
Practice Address - Street 1:3830 BRINKMAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6311
Practice Address - Country:US
Practice Address - Phone:713-826-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77801101YM0800X, 101YP2500X, 101Y00000X
TX1772725101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool