Provider Demographics
NPI:1376802165
Name:SCHWENKLER, RON GEORGE II (MA)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:GEORGE
Last Name:SCHWENKLER
Suffix:II
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 MINERS CANDLE PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3567
Mailing Address - Country:US
Mailing Address - Phone:406-531-8996
Mailing Address - Fax:
Practice Address - Street 1:4212 MINERS CANDLE PL
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3567
Practice Address - Country:US
Practice Address - Phone:406-531-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011241101YM0800X
WV1863101YP2500X
MT1305-LCPC101YP2500X
MT12106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist