MEDICARE: MR. RONALD SIMPSON JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093189169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD SIMPSON JR.

Provider Business Mailing Address
First Line	:	4020 CALIFORNIA LN
Second Line	:
City	:	OAK RIDGE
State	:	LA
Zip	:	71264-9331
Country	:	US
Telephone Number	:	318-244-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	4951 CENTRAL AVE
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203
Country	:	US
Telephone Number	:	318-649-6399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	05/30/2018

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