Provider Demographics
NPI:1184822520
Name:VONRAVENSBERG, RUDOLPH (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:
Last Name:VONRAVENSBERG
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 AIRMOTIVE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3294
Mailing Address - Country:US
Mailing Address - Phone:775-453-4143
Mailing Address - Fax:775-996-5616
Practice Address - Street 1:1325 AIRMOTIVE WAY STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3294
Practice Address - Country:US
Practice Address - Phone:775-453-4143
Practice Address - Fax:775-996-5616
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist