Healthcare Provider Details

I. General information

NPI: 1629549548
Provider Name (Legal Business Name): RYAN ILYSSE SNODGRASS LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 HARDING ST
CARLSBAD CA
92008-1815
US

IV. Provider business mailing address

2942 HARDING ST
CARLSBAD CA
92008-1815
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-3281
  • Fax:
Mailing address:
  • Phone: 562-285-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: