Provider Demographics
NPI:1902065337
Name:ANDERSON, RONALD CARROLL (LPC IN CANDIDACY)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CARROLL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC IN CANDIDACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5630
Mailing Address - Country:US
Mailing Address - Phone:580-231-0878
Mailing Address - Fax:
Practice Address - Street 1:502 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5630
Practice Address - Country:US
Practice Address - Phone:580-231-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health