Healthcare Provider Details

I. General information

NPI: 1013701598
Provider Name (Legal Business Name): RYAN CHRISTOPHER BAIN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

IV. Provider business mailing address

511 N BROOKHURST ST STE 200
ANAHEIM CA
92801-5229
US

V. Phone/Fax

Practice location:
  • Phone: 714-222-0282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: