Provider Demographics
NPI:1174993802
Name:RENNER, SAMANTHA (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:MARTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4736
Mailing Address - Country:US
Mailing Address - Phone:509-866-4112
Mailing Address - Fax:509-588-7437
Practice Address - Street 1:3754 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4736
Practice Address - Country:US
Practice Address - Phone:509-866-4112
Practice Address - Fax:509-588-7437
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60476471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health