Provider Demographics
NPI:1568844843
Name:PERISHO, RYAN JULIE (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:RYAN
Middle Name:JULIE
Last Name:PERISHO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 FASHION ISLAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-5043
Mailing Address - Country:US
Mailing Address - Phone:805-556-7220
Mailing Address - Fax:
Practice Address - Street 1:1510 FASHION ISLAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-5043
Practice Address - Country:US
Practice Address - Phone:805-556-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 101Y00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor