MEDICARE: MR. RON JAMES PATRICK LCSW

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	1041C0700X	Clinical Social Worker	109337	TX

General Provider Information

NPI Number	:	1689385486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RON JAMES PATRICK LCSW

Provider Business Mailing Address
First Line	:	PO BOX 10284
Second Line	:
City	:	KILLEEN
State	:	TX
Zip	:	76547-0284
Country	:	US
Telephone Number	:	254-213-1501
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 W AVENUE O # B-6
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6415
Country	:	US
Telephone Number	:	254-213-1501
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	04/01/2026

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