Provider Demographics
NPI:1538330493
Name:MAIER, RONALD ANTON (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ANTON
Last Name:MAIER
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W KELSEY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-1619
Mailing Address - Country:US
Mailing Address - Phone:309-828-2965
Mailing Address - Fax:309-828-2965
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:BLDG 8
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1493
Practice Address - Country:US
Practice Address - Phone:309-828-2965
Practice Address - Fax:309-828-2965
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-00963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health