Provider Demographics
NPI:1730533183
Name:RENFRO, CEAETTA HARRIS
Entity type:Individual
Prefix:MRS
First Name:CEAETTA
Middle Name:HARRIS
Last Name:RENFRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CEAETTAS
Other - Middle Name:FAMILY
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 793
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612
Mailing Address - Country:US
Mailing Address - Phone:409-383-8399
Mailing Address - Fax:
Practice Address - Street 1:215 COUNTY ROAD 746
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612-6333
Practice Address - Country:US
Practice Address - Phone:409-383-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health