Provider Demographics
NPI:1093029050
Name:YOUNG, RYAN E (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:MCDONOUGH-DUGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30650 RANCHO CALIFORNIA RD STE D406-75
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3215
Mailing Address - Country:US
Mailing Address - Phone:951-795-4736
Mailing Address - Fax:
Practice Address - Street 1:41690 ENTERPRISE CIR N STE 201
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5627
Practice Address - Country:US
Practice Address - Phone:951-795-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92362106H00000X
225400000X
CA64456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner