Provider Demographics
NPI:1306905625
Name:RONAN PSYCHOLOGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:RONAN PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSCHBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, ACS
Authorized Official - Phone:989-779-8999
Mailing Address - Street 1:411 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2444
Mailing Address - Country:US
Mailing Address - Phone:989-779-8999
Mailing Address - Fax:989-419-5953
Practice Address - Street 1:411 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2444
Practice Address - Country:US
Practice Address - Phone:989-779-8999
Practice Address - Fax:989-419-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP06880Medicare UPIN