Provider Demographics
NPI:1811201528
Name:DEWEESE, RONALD EDWARD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:EDWARD
Other - Last Name:DEWEESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:200 ZANE DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-8534
Mailing Address - Country:US
Mailing Address - Phone:417-776-9313
Mailing Address - Fax:
Practice Address - Street 1:200 ZANE DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865-8534
Practice Address - Country:US
Practice Address - Phone:417-776-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional