Provider Demographics
NPI:1548628324
Name:RENFROE, DEBORAH KAY (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAY
Last Name:RENFROE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18521 E. QUEEN CREEK
Mailing Address - Street 2:STE 105-627
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5870
Mailing Address - Country:US
Mailing Address - Phone:480-361-1025
Mailing Address - Fax:480-814-4788
Practice Address - Street 1:18521 E. QUEEN CREEK RD
Practice Address - Street 2:STE 105-627
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5870
Practice Address - Country:US
Practice Address - Phone:480-361-1025
Practice Address - Fax:480-814-4788
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst