Provider Demographics
NPI:1942589791
Name:RANSAW, MIKE (EDS, MS)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:RANSAW
Suffix:
Gender:M
Credentials:EDS, MS
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:RANSAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDS, MS
Mailing Address - Street 1:2751 SANGER TER
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1926
Mailing Address - Country:US
Mailing Address - Phone:954-801-7365
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health