Healthcare Provider Details

I. General information

NPI: 1164183067
Provider Name (Legal Business Name): RONALD TY NORSWORTHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 W REYNOLDS AVE
CENTRALIA WA
98531-4554
US

IV. Provider business mailing address

3510 STEELHAMMER DR
CENTRALIA WA
98531-4551
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-9044
  • Fax: 360-736-3139
Mailing address:
  • Phone: 360-623-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: