Healthcare Provider Details

I. General information

NPI: 1750319471
Provider Name (Legal Business Name): RONALD LOUIS OBER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 CALISTOGA DR
HOLLISTER CA
95023-6255
US

IV. Provider business mailing address

2160 CALISTOGA DR
HOLLISTER CA
95023-6255
US

V. Phone/Fax

Practice location:
  • Phone: 831-637-6787
  • Fax:
Mailing address:
  • Phone: 831-637-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS10843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: