Basic Information
| Provider Information | |||||||||
| NPI: | 1427106178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEAD | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFT,CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2976 BALLESTEROS LN | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927821127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145443604 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 S MCDONNELL AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900405623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239814301 | ||||||||
| FaxNumber: | 3238816733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC24950 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.