MEDICARE: RYAN FORREST MATHEW CALL LCSW

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	1041C0700X	Clinical Social Worker	8271692	ID
2	1041C0700X	Clinical Social Worker	10830955-3501	UT
3	1041C0700X	Clinical Social Worker	LCSW-23772	AZ

General Provider Information

NPI Number	:	1730771809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN FORREST MATHEW CALL LCSW

Provider Business Mailing Address
First Line	:	1255 W BASELINE RD STE A212
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-5820
Country	:	US
Telephone Number	:	809-313-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 W BASELINE RD STE A212
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-5820
Country	:	US
Telephone Number	:	385-390-1987
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	06/16/2026

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