Provider Demographics
NPI:1083021232
Name:STEVENSON, RYAN FORD (PHD, MSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:FORD
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 CYPRESS WALK
Mailing Address - Street 2:APT F
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3008
Mailing Address - Country:US
Mailing Address - Phone:801-367-2488
Mailing Address - Fax:
Practice Address - Street 1:766 CYPRESS WALK
Practice Address - Street 2:APT F
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3008
Practice Address - Country:US
Practice Address - Phone:801-367-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
UT6634020-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical