Provider Demographics
NPI:1275159659
Name:RENZI, JOEY REESE (BCBA)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:REESE
Last Name:RENZI
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:REESE
Other - Last Name:PUGMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JOEY REESE PUGMIRE
Mailing Address - Street 1:528 E SPOKANE FALLS BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5081
Mailing Address - Country:US
Mailing Address - Phone:509-381-4142
Mailing Address - Fax:
Practice Address - Street 1:528 E SPOKANE FALLS BLVD STE 14
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5081
Practice Address - Country:US
Practice Address - Phone:509-381-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-22-63097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst