MEDICARE: RYAN MATTHEW SWEAT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	135047	CA

General Provider Information

NPI Number	:	1356067672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MATTHEW SWEAT LMFT

Provider Business Mailing Address
First Line	:	1200 24TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-2433
Country	:	US
Telephone Number	:	650-766-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	10054 CAMBRIDGE BLUE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7718
Country	:	US
Telephone Number	:	510-519-7170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	03/26/2025

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