Provider Demographics
NPI:1538190855
Name:KORN, RONALD DAVID (MFT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DAVID
Last Name:KORN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6442 COLDWATER CANYON AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1137
Mailing Address - Country:US
Mailing Address - Phone:818-991-5166
Mailing Address - Fax:818-763-6553
Practice Address - Street 1:6442 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1137
Practice Address - Country:US
Practice Address - Phone:818-991-5166
Practice Address - Fax:818-763-6553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 20172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist