Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | ||
N | 1041C0700X | Clinical Social Worker | 6634020-3501 | UT |
NPI | 1083021232 |
---|---|
Provider Name | Mr. Ryan Ford Stevenson |
First Address | Goleta, CA 93117-3008 |
Second Address | Goleta, CA 93117-3008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2014 |
Last Update Date | 21/07/2014 |