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General NPI Number Information
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NPI Number | 1023721909
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Entity Type | Organization
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Legal Business Name | RONON'S PLACE
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 8119 W M 68 HWY
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City | INDIAN RIVER
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State | MI
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Zip | 49749-9014
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Country | US
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Telephone | 231-463-1560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 141
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City | INDIAN RIVER
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State | MI
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Zip | 49749-0141
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Country | US
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Telephone | 231-463-1560
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BECKY L FETTIG
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Credential |
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Telephone | 231-463-1560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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