Healthcare Provider Details

I. General information

NPI: 1316875388
Provider Name (Legal Business Name): RONALD GENE SIMS SPECIALIZED M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PRIVATE DRIVE 2265
SOUTH POINT OH
45680-8952
US

IV. Provider business mailing address

106 PRIVATE DRIVE 2265
SOUTH POINT OH
45680-8952
US

V. Phone/Fax

Practice location:
  • Phone: 304-617-2772
  • Fax:
Mailing address:
  • Phone: 304-617-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP50
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: