Provider Demographics
NPI:1689385486
Name:PATRICK, RON JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:JAMES
Last Name:PATRICK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10284
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0284
Mailing Address - Country:US
Mailing Address - Phone:254-213-1501
Mailing Address - Fax:
Practice Address - Street 1:2820 W AVENUE O # B-6
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6415
Practice Address - Country:US
Practice Address - Phone:254-213-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker