Provider Demographics
NPI:1598177941
Name:RONNING, DOUG (MFT, RDT)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:RONNING
Suffix:
Gender:M
Credentials:MFT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAYHEW WAY STE 1003
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4370
Mailing Address - Country:US
Mailing Address - Phone:415-902-5638
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY STE 1003
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4370
Practice Address - Country:US
Practice Address - Phone:415-902-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist