Provider Demographics
NPI:1780213504
Name:BUCHHOLZ, RYAN MARIA PETER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MARIA PETER
Last Name:BUCHHOLZ
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 1:1901 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-3911
Mailing Address - Country:US
Mailing Address - Phone:415-845-0515
Mailing Address - Fax:
Practice Address - Street 1:1611 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1375
Practice Address - Country:US
Practice Address - Phone:510-488-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist