Provider Demographics
NPI:1952689036
Name:OLGUIN, RONALD GERALD JR (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GERALD
Last Name:OLGUIN
Suffix:JR
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11930 MENAUL BLVD NE
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2478
Mailing Address - Country:US
Mailing Address - Phone:505-294-2722
Mailing Address - Fax:505-294-2922
Practice Address - Street 1:11930 MENAUL BLVD NE
Practice Address - Street 2:SUITE 106A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-294-2722
Practice Address - Fax:505-294-2922
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0131411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06557023Medicaid