Provider Demographics
NPI:1053686642
Name:DEAGE, RON (MA,LPC,LCDC,LMFT)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:DEAGE
Suffix:
Gender:M
Credentials:MA,LPC,LCDC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 BRENT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-4976
Mailing Address - Country:US
Mailing Address - Phone:830-885-2060
Mailing Address - Fax:830-885-2060
Practice Address - Street 1:9681 W LOOP 1604 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5303
Practice Address - Country:US
Practice Address - Phone:210-688-9434
Practice Address - Fax:210-688-3859
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health