Provider Demographics
NPI:1588215842
Name:BARKER, RYAN THOMAS (CATC II)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:BARKER
Suffix:
Gender:M
Credentials:CATC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2157
Mailing Address - Country:US
Mailing Address - Phone:951-427-3482
Mailing Address - Fax:
Practice Address - Street 1:109 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2157
Practice Address - Country:US
Practice Address - Phone:951-427-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191029II101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)