| Doctor Name: | DR. CARL T. RENFRO |
| NPI Number: | 1124268255 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PSY-170 |
| Business Practice Address: | 221 S 2nd Ave Sandpoint, ID - 838641310 |
| Business Phone Number: | 2082631736 |
| Business Fax Number: | |
| Mailing Address: | 221 S 2nd Ave, SANDPOINT |
| State: | ID |
| Postal Code: | 838641310 |
| Phone Number: | 2082631736 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 03/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY-170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |