Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2686 | OR |
Y | 103TC0700X | Clinical Psychologist | 2686 | OR |
N | 103G00000X | Clinical Psychologist | 71007292 | IL |
N | 103TC0700X | Clinical Psychologist | 71007292 | IL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 71007292 | IL |
N | 103G00000X | Clinical Psychologist | 71007292 | IL |
N | 103TC0700X | Clinical Psychologist | 71007292 | IL |
N | 103TF0200X | Forensic Psychologist | 71007292 | IL |
N | 103TH0004X | Health Psychologist | 71007292 | IL |
NPI | 1205046422 |
---|---|
Provider Name | Dr. Laura Renteria |
First Address | Chesterton, IN 46304-0357 |
Second Address | Beaverton, OR 97003-2999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 21/10/2016 |