Provider Demographics
NPI:1467857417
Name:RYAN, ANNA R (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:R
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 DENVER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3340
Mailing Address - Country:US
Mailing Address - Phone:619-276-0747
Mailing Address - Fax:
Practice Address - Street 1:2519 DENVER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3340
Practice Address - Country:US
Practice Address - Phone:619-276-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24640OtherLMFT