RENA SUSAN DEREZIN, M.A., L.P.C., N.C.C. — NPI 1790923670 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1790923670

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

101YP2500X (CMS E2)

Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor

Box 32 Service Location & ZIP+4

135 CLEAR CREEK STREET, BLACK HAWK, CO, 80422-0418

✓ 9-Digit EDI 837 ZIP+4 (80422-0418)

Practice Phone & Referral Fax

(303) 807-2750

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1790923670 (RENA SUSAN DEREZIN, M.A., L.P.C., N.C.C.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1790923670` (NPI-1 Individual Practitioner)
Provider / Legal Name	RENA SUSAN DEREZIN, M.A., L.P.C., N.C.C.
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor NUCC Code: `101YP2500X` (Counselor, Professional)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	135 CLEAR CREEK STREET, BLACK HAWK, CO, 80422-0418
Practice Telephone / Fax	Tel: (303) 807-2750
Administrative Mailing Address	PO BOX 139, SILVERTHORNE, CO, 80498-0139
Enumeration & Last Sync	Enumerated: 2009-01-30 \| CMS Record Updated: 2009-08-25

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

135 CLEAR CREEK STREET, BLACK HAWK, CO, 80422-0418

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Plain-English Taxonomy & CMS Crosswalk (101YP2500X)

What Does Taxonomy Code 101YP2500X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 101YP2500X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code E2 (Licensed Professional Counselor)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Counselor, Professional for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RENA SUSAN DEREZIN, M.A., L.P.C., N.C.C.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: CO \| License: `5066` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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RENA SUSAN DEREZIN, M.A., L.P.C., N.C.C. (NPI #1790923670)