Provider Demographics
NPI:1215204300
Name:FRITZ, RON (CADC III, MSP, QMHP)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:FRITZ
Suffix:
Gender:M
Credentials:CADC III, MSP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2307
Mailing Address - Country:US
Mailing Address - Phone:949-933-0742
Mailing Address - Fax:
Practice Address - Street 1:239 E. ELLENDALE
Practice Address - Street 2:SUITE 602
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-623-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-06-56101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health