Provider Demographics
NPI:1912303025
Name:POPKIN, RYAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:POPKIN
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SW TAYLOR ST STE 448
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2509
Mailing Address - Country:US
Mailing Address - Phone:805-709-1620
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 448
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2509
Practice Address - Country:US
Practice Address - Phone:971-394-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131367106H00000X
ORT2162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist