Provider Demographics
NPI:1649833195
Name:RYAN, JOSEPH MICHAEL (MFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:RYAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 W 149TH PL UNIT 11
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6674
Mailing Address - Country:US
Mailing Address - Phone:323-346-8613
Mailing Address - Fax:323-346-8613
Practice Address - Street 1:5514 W 149TH PL UNIT 11
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6674
Practice Address - Country:US
Practice Address - Phone:323-346-8613
Practice Address - Fax:323-346-8613
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT44561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist