Healthcare Provider Details

I. General information

NPI: 1740058692
Provider Name (Legal Business Name): RYAN PLUMB MS, AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LINCOLN AVENUE SUITE 103
SAN RAFAEL CA
94901-2141
US

IV. Provider business mailing address

1330 LINCOLN AVENUE SUITE 103
SAN RAFAEL CA
94901-2141
US

V. Phone/Fax

Practice location:
  • Phone: 415-779-2496
  • Fax:
Mailing address:
  • Phone: 415-779-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13462
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: