Provider Demographics
NPI:1639345234
Name:EDEAL, RON E (MFT)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:E
Last Name:EDEAL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 VALENCIA AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4164
Mailing Address - Country:US
Mailing Address - Phone:831-460-2550
Mailing Address - Fax:831-688-1718
Practice Address - Street 1:3040 VALENCIA AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4164
Practice Address - Country:US
Practice Address - Phone:831-460-2550
Practice Address - Fax:831-688-1718
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist