Provider Demographics
NPI:1437633484
Name:DELONG, PETERSON & ASSOCIATES, CLINICAL CONSULTING SPECIALISTS, LLC
Entity Type:Organization
Organization Name:DELONG, PETERSON & ASSOCIATES, CLINICAL CONSULTING SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-305-7213
Mailing Address - Street 1:607 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1929
Mailing Address - Country:US
Mailing Address - Phone:419-305-7213
Mailing Address - Fax:937-547-9175
Practice Address - Street 1:607 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1929
Practice Address - Country:US
Practice Address - Phone:419-305-7213
Practice Address - Fax:937-547-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-16
Last Update Date:2018-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty