Provider Demographics
NPI:1447784178
Name:MOORE, RYAN (MFTI)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 SUTTER ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5427
Mailing Address - Country:US
Mailing Address - Phone:415-346-6994
Mailing Address - Fax:
Practice Address - Street 1:1388 SUTTER ST
Practice Address - Street 2:SUITE 412
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5427
Practice Address - Country:US
Practice Address - Phone:415-346-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF98599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional