Healthcare Provider Details

I. General information

NPI: 1851743850
Provider Name (Legal Business Name): RYAN G WITHERSPOON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E COLORADO BLVD STE 425
PASADENA CA
91105-3729
US

IV. Provider business mailing address

117 E COLORADO BLVD STE 425
PASADENA CA
91105-3729
US

V. Phone/Fax

Practice location:
  • Phone: 626-559-0939
  • Fax:
Mailing address:
  • Phone: 626-559-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: