Provider Demographics
NPI:1760859938
Name:LANDSTEDT, RYAN NELSON (LMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NELSON
Last Name:LANDSTEDT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 CAMINO DEL RIO S STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3729
Mailing Address - Country:US
Mailing Address - Phone:619-335-5270
Mailing Address - Fax:
Practice Address - Street 1:4666 W SAN SALVO DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5019
Practice Address - Country:US
Practice Address - Phone:619-884-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111448106H00000X
ID11764917171400000X, 101Y00000X, 101YP1600X
CALMFT111448106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral