Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | D6038966 | CA |
NPI | 1003057886 |
---|---|
Provider Name | Ryan Roleson |
First Address | Bakersfield, CA 93306-4018 |
Second Address | Bakersfield, CA 93306-4018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2009 |
Last Update Date | 09/05/2019 |