Provider Demographics
NPI:1194849042
Name:RYONO, SUSAN GRACE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GRACE
Last Name:RYONO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 TORRANCE BLVD
Mailing Address - Street 2:#845
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4100
Mailing Address - Country:US
Mailing Address - Phone:562-388-7807
Mailing Address - Fax:562-388-7663
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1336
Practice Address - Country:US
Practice Address - Phone:562-388-7807
Practice Address - Fax:562-388-7663
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist