MEDICARE: RONAN PSYCHOLOGICAL ASSOCIATES, LLC

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	103TC0700X	Clinical Psychologist	6301007695	MI

General Provider Information

NPI Number	:	1306905625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONAN PSYCHOLOGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	411 W BROADWAY ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2444
Country	:	US
Telephone Number	:	989-779-8999
Fax Number	:	989-419-5953

Provider Business Practice Location Address
First Line	:	411 W BROADWAY ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2444
Country	:	US
Telephone Number	:	989-779-8999
Fax Number	:	989-419-5953

Authorized Official
Title or Position	:	OWNER
Name	:	AMY PERSCHBACHER
Credential	:	LPC, NCC, ACS
Telephone Number	:	989-779-8999

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	02/07/2023

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