Provider Demographics
NPI:1013264480
Name:RYAN, ANNE MAUREEN (IMF)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MAUREEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6023
Mailing Address - Country:US
Mailing Address - Phone:562-431-9293
Mailing Address - Fax:562-431-8386
Practice Address - Street 1:200 MARINA DR
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6023
Practice Address - Country:US
Practice Address - Phone:562-431-9293
Practice Address - Fax:562-431-8386
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist