Provider Demographics
NPI:1912563248
Name:LISMAN, RYAN (MA, APCC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LISMAN
Suffix:
Gender:M
Credentials:MA, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 COUNTRY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2560
Mailing Address - Country:US
Mailing Address - Phone:818-397-2738
Mailing Address - Fax:
Practice Address - Street 1:16600 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3875
Practice Address - Country:US
Practice Address - Phone:818-386-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health