MEDICARE: RONALDO C YOUNGBLUT LMSW

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	117015	TX

General Provider Information

NPI Number	:	1699625004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALDO C YOUNGBLUT LMSW

Provider Business Mailing Address
First Line	:	1533 1/2 HEIGHTS BLVD REAR BUILDING
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4218
Country	:	US
Telephone Number	:	281-245-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 1/2 HEIGHTS BLVD REAR BUILDING
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4218
Country	:	US
Telephone Number	:	281-245-0123
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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