Provider Demographics
NPI:1356891428
Name:MURRAY, RONALD GREGORY (LSW, LCDC-III)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GREGORY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:LSW, LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 VENICE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3351
Mailing Address - Country:US
Mailing Address - Phone:614-946-2638
Mailing Address - Fax:
Practice Address - Street 1:1481 VENICE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3351
Practice Address - Country:US
Practice Address - Phone:614-946-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131192101YA0400X
OHS.0600786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)