Doctor Name: | MR. RON MABRY |
NPI Number: | 1003281700 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 2772 S. Martin Luther King Blvd Fresno, CA - 93706 |
Business Phone Number: | 5592654800 |
Business Fax Number: | |
Mailing Address: | 3456 E Illinois Ave, FRESNO |
State: | CA |
Postal Code: | 937022027 |
Phone Number: | 5592654800 |
Fax Number: | |
NPI Enumeration Date: | 12/07/2015 |
NPI Last Update Date: | 12/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |