Healthcare Provider Details

I. General information

NPI: 1114691912
Provider Name (Legal Business Name): RYAN MCCUNE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W FOOTHILL BLVD STE C
CLAREMONT CA
91711-3356
US

IV. Provider business mailing address

915 W FOOTHILL BLVD STE C
CLAREMONT CA
91711-3356
US

V. Phone/Fax

Practice location:
  • Phone: 909-255-0688
  • Fax:
Mailing address:
  • Phone: 909-255-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number113458
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW113458
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: