Provider Demographics
NPI:1538725510
Name:RENNELS, GLYNIS VICTORIA ELIZABETH (LCSW-BACS)
Entity type:Individual
Prefix:
First Name:GLYNIS
Middle Name:VICTORIA ELIZABETH
Last Name:RENNELS
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:GLYNIS
Other - Middle Name:RENNELS
Other - Last Name:DEROCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:100 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5117
Mailing Address - Country:US
Mailing Address - Phone:337-962-4017
Mailing Address - Fax:
Practice Address - Street 1:143 RIDGEWAY DR STE 106
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3410
Practice Address - Country:US
Practice Address - Phone:337-993-1960
Practice Address - Fax:337-993-1961
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical