Provider Demographics
NPI:1780801803
Name:POWERS, RONALD DEWAYNE (MFT PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:DEWAYNE
Last Name:POWERS
Suffix:
Gender:M
Credentials:MFT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KALMUS DR
Mailing Address - Street 2:K1
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5988
Mailing Address - Country:US
Mailing Address - Phone:714-384-3870
Mailing Address - Fax:714-384-3875
Practice Address - Street 1:151 KALMUS DR
Practice Address - Street 2:K1
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5988
Practice Address - Country:US
Practice Address - Phone:714-384-3870
Practice Address - Fax:714-384-3875
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist