Healthcare Provider Details

I. General information

NPI: 1952689036
Provider Name (Legal Business Name): RONALD GERALD OLGUIN JR. MA, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 MENAUL BLVD NE SUITE 106A
ALBUQUERQUE NM
87112-2478
US

IV. Provider business mailing address

11930 MENAUL BLVD NE SUITE 106A
ALBUQUERQUE NM
87112-2478
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-2722
  • Fax: 505-294-2922
Mailing address:
  • Phone: 505-294-2722
  • Fax: 505-294-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0131411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: