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General NPI Number Information
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NPI Number | 1215204300
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Entity Type | Individual
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Provider Name | RON FRITZ CADC III, MSP, QMHP
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Gender | Male
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 239 E. ELLENDALE SUITE 602
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City | DALLAS
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State | OR
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Zip | 97338
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Country | US
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Telephone | 503-623-3593
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Fax |
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Provider Business Mailing Address
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Address Line | 1491 SW 10TH ST
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City | DALLAS
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State | OR
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Zip | 97338-2307
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Country | US
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Telephone | 949-933-0742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10-06-56
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License Number State | OR
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Taxonomy #2
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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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