Provider Demographics
NPI:1124600200
Name:RENNER, NICOLE (MS, LPCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E CALGARY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0938
Mailing Address - Country:US
Mailing Address - Phone:701-502-0502
Mailing Address - Fax:701-502-0602
Practice Address - Street 1:1401 E CALGARY AVE STE 210
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0938
Practice Address - Country:US
Practice Address - Phone:701-502-0502
Practice Address - Fax:701-502-0602
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1126-5-15-21A101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health