Provider Demographics
NPI:1558627729
Name:FELTON, RONALD CHARLES (LADC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CHARLES
Last Name:FELTON
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 CEDAR
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337
Mailing Address - Country:US
Mailing Address - Phone:402-984-1839
Mailing Address - Fax:
Practice Address - Street 1:305 FOCH STREET
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343
Practice Address - Country:US
Practice Address - Phone:308-282-1101
Practice Address - Fax:308-282-1372
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE155804640Medicaid
NE47073437686Medicaid