Healthcare Provider Details

I. General information

NPI: 1376419507
Provider Name (Legal Business Name): RON G DEMING MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 BRAY AVE
SPRING VALLEY CA
91977-2822
US

IV. Provider business mailing address

9565 BRAY AVE
SPRING VALLEY CA
91977-2822
US

V. Phone/Fax

Practice location:
  • Phone: 619-403-4914
  • Fax:
Mailing address:
  • Phone: 619-403-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number121092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: