Provider Demographics
NPI:1720541865
Name:TITSWORTH, RYAN CARL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CARL
Last Name:TITSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 HOLLYLEAF LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3527
Mailing Address - Country:US
Mailing Address - Phone:408-802-0444
Mailing Address - Fax:
Practice Address - Street 1:16275 MONTEREY RD STE C
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5466
Practice Address - Country:US
Practice Address - Phone:408-778-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6201101YP2500X
CA112699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional