Healthcare Provider Details

I. General information

NPI: 1821294687
Provider Name (Legal Business Name): TAMI RYDER LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

300 N SAN ANTONIO RD BLDG 3
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 831-359-7841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: