Provider Demographics
NPI:1811049125
Name:BAPTIST, RONALD R (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:R
Last Name:BAPTIST
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 DOMINION WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1484
Mailing Address - Country:US
Mailing Address - Phone:719-477-0203
Mailing Address - Fax:719-426-2258
Practice Address - Street 1:1925 DOMINION WAY STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1484
Practice Address - Country:US
Practice Address - Phone:719-477-0203
Practice Address - Fax:719-426-2258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1726101YM0800X
COLP0001726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1811049145Medicaid
CO9000148990Medicaid