Active NPI
Carl T. Renfro III, PH.D.
- Clinical Psychologist
- Sandpoint, ID
National Provider Identifier
1124268255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY-170
- Practice address
- 221 S 2ND Ave
Sandpoint, ID 83864-1310 - Phone
- (208) 263-1736
- NPI assigned
- Mar 2, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-170 | ID | Primary |
Addresses
Primary practice location
221 S 2ND Ave
Sandpoint, ID 83864-1310
Mailing address
221 S 2ND Ave
Sandpoint, ID 83864-1310
Phone (208) 263-1736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-170 | ID | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1124268255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 S 2ND AVE",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641310",
"telephone_number": "208-263-1736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 S 2ND AVE",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641310",
"telephone_number": "208-263-1736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENFRO",
"first_name": "CARL",
"middle_name": "T.",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-02",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "ID",
"license": "PSY-170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.