Provider Demographics
NPI:1366552648
Name:BONEY, RON JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:JAY
Last Name:BONEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SANTA FE DR STE C
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6525
Mailing Address - Country:US
Mailing Address - Phone:817-599-4781
Mailing Address - Fax:817-599-7611
Practice Address - Street 1:804 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6525
Practice Address - Country:US
Practice Address - Phone:817-599-4781
Practice Address - Fax:817-599-7611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0976920-01Medicaid
TX2046-01OtherPACIFICARE
TX000000BY09OtherBLUECROSS BLUESHIELD
TX282164OtherVALUEOPTIONS
TX0004367855OtherAETNA PPO
TX2046-01OtherPACIFICARE