Provider Demographics
NPI:1326371444
Name:RODNEY, RONALD JOHN (LPC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:RODNEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 BLUE MOON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1014
Mailing Address - Country:US
Mailing Address - Phone:405-501-2829
Mailing Address - Fax:
Practice Address - Street 1:11909 BLUE MOON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-1014
Practice Address - Country:US
Practice Address - Phone:405-501-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health