Provider Demographics
NPI:1396714002
Name:RONSO, LEE (LMFT)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:RONSO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 JOSHUA DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-4533
Mailing Address - Country:US
Mailing Address - Phone:850-452-6776
Mailing Address - Fax:
Practice Address - Street 1:640 ROBERTS AVE
Practice Address - Street 2:CORRY STATION BLDG 3776
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32511-5155
Practice Address - Country:US
Practice Address - Phone:850-452-6776
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002170101YP2500X
MST0184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist