Active NPI
Larissa Lanae Rennaker
- Behavior Technician
- Colorado Springs, CO
National Provider Identifier
1588315832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-193091
- Practice address
- 2105 Academy Cir Ste 100
Colorado Springs, CO 80909-1664 - Phone
- (719) 252-2984
- NPI assigned
- Jan 18, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-21-193091 | CO | Primary |
Addresses
Primary practice location
2105 Academy Cir Ste 100
Colorado Springs, CO 80909-1664
Mailing address
4070 Turnberry CT
Colorado Springs, CO 80909-1719
Phone (719) 252-2984
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://members.centralreach.com |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-21-193091 | CO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1588315832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4070 TURNBERRY CT",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809091719",
"telephone_number": "719-252-2984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 ACADEMY CIR STE 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809091664",
"telephone_number": "719-252-2984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNAKER",
"first_name": "LARISSA",
"middle_name": "LANAE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-18",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "RBT-21-193091",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://members.centralreach.com",
"affiliation": "N",
"address_1": "401 Broadway Ave",
"city": "Pueblo",
"state": "CO",
"country_code": "US",
"postal_code": "810042127",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.