Healthcare Provider Details

I. General information

NPI: 1306219555
Provider Name (Legal Business Name): RYAN SCOTT HERALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD STE A
OXNARD CA
93033-3608
US

IV. Provider business mailing address

403 ELLWOOD BEACH DR APT 2
GOLETA CA
93117-2561
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 310-876-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number89640
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: