Healthcare Provider Details

I. General information

NPI: 1396714002
Provider Name (Legal Business Name): LEE RONSO LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ROBERTS AVE CORRY STATION BLDG 3776
PENSACOLA FL
32511-5155
US

IV. Provider business mailing address

1936 JOSHUA DR
CANTONMENT FL
32533-4533
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-6776
  • Fax:
Mailing address:
  • Phone: 850-452-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401002170
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0184
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: