Provider Demographics
NPI:1891587861
Name:MAHONEY, RENATA D (LPC, NCC, NCSC)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:D
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 E. 70TH STREET
Mailing Address - Street 2:SUITE C AND D
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-759-7020
Mailing Address - Fax:318-383-0698
Practice Address - Street 1:1950 E. 70TH STREET
Practice Address - Street 2:SUITE C AND D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-759-7020
Practice Address - Fax:318-383-0698
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health