Provider Demographics
NPI:1811234685
Name:DRUKH, RENATA (LMHC)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:DRUKH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 MC LAURIN RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6509
Mailing Address - Country:US
Mailing Address - Phone:847-293-8864
Mailing Address - Fax:
Practice Address - Street 1:10163 MC LAURIN RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6509
Practice Address - Country:US
Practice Address - Phone:847-293-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22132101YM0800X
IL180007254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health