Provider Demographics
NPI:1881222081
Name:BEAN, RONALD C (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:BEAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 N MOOSE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5449
Mailing Address - Country:US
Mailing Address - Phone:602-799-4929
Mailing Address - Fax:602-775-2705
Practice Address - Street 1:943 W OVERLAND RD STE 161
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6541
Practice Address - Country:US
Practice Address - Phone:602-799-4929
Practice Address - Fax:602-775-2705
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY005246103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty