Provider Demographics
NPI:1740058692
Name:PLUMB, RYAN (MS, AMFT, APCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PLUMB
Suffix:
Gender:M
Credentials:MS, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 LINCOLN AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2143
Mailing Address - Country:US
Mailing Address - Phone:415-779-2496
Mailing Address - Fax:
Practice Address - Street 1:1330 LINCOLN AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2143
Practice Address - Country:US
Practice Address - Phone:415-779-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13462101YP2500X
CA138074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional