Provider Demographics
NPI:1255791463
Name:PFEFFER, RENEE SUSANN (MA, LPC INTERN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:SUSANN
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OLYMPIA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1855
Mailing Address - Country:US
Mailing Address - Phone:972-989-6743
Mailing Address - Fax:
Practice Address - Street 1:1430 ROBINSON RD # 430
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-3154
Practice Address - Country:US
Practice Address - Phone:940-222-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional