Healthcare Provider Details

I. General information

NPI: 1972621654
Provider Name (Legal Business Name): MICHAEL RYDMAN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E ST
MODESTO CA
95354-2411
US

IV. Provider business mailing address

2000 W BRIGGSMORE AVE SUITE I
MODESTO CA
95350-3839
US

V. Phone/Fax

Practice location:
  • Phone: 209-204-1230
  • Fax:
Mailing address:
  • Phone: 209-526-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: