Provider Demographics
NPI:1205994464
Name:AMES, RALPH LEONARD (PHD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:LEONARD
Last Name:AMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WEST COLLEGE AVE
Mailing Address - Street 2:# 439
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401
Mailing Address - Country:US
Mailing Address - Phone:707-508-6361
Mailing Address - Fax:707-527-5395
Practice Address - Street 1:865 THIRD ST
Practice Address - Street 2:# 203
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-508-6361
Practice Address - Fax:707-527-5395
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical