Provider Demographics
NPI:1215193198
Name:HUSTON, RONALD GEORGE (LCP,LCSW,MFT)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEORGE
Last Name:HUSTON
Suffix:
Gender:M
Credentials:LCP,LCSW,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37375 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-9589
Mailing Address - Country:US
Mailing Address - Phone:909-570-9089
Mailing Address - Fax:909-570-9617
Practice Address - Street 1:37375 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-9589
Practice Address - Country:US
Practice Address - Phone:909-570-9089
Practice Address - Fax:909-570-9617
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10341103TC0700X
CALH0074851041C0700X
CAMZ23750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist