MEDICARE: RYAN CHRISTOPHER BETHEM 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	88478	CA

General Provider Information

NPI Number	:	1447627799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN CHRISTOPHER BETHEM LMFT

Provider Business Mailing Address
First Line	:	1381 S VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-4017
Country	:	US
Telephone Number	:	916-296-2613
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 BUSH ST
Second Line	:	FLOOR #7
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-3623
Country	:	US
Telephone Number	:	415-553-5524
Fax Number	:

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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