Basic Information
| Provider Information | |||||||||
| NPI: | 1114568433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARRA | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | SUDRC #11570 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 N 1ST ST STE 135&154 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592251464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3636 N 1ST ST STE 135&154 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592251464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2019 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 11570 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.