Healthcare Provider Details

I. General information

NPI: 1194213983
Provider Name (Legal Business Name): RYAN JAMES GOGARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date: 05/25/2018
Reactivation Date: 06/05/2018

III. Provider practice location address

1399 YGNACIO VALLEY RD STE 24
WALNUT CREEK CA
94598-2869
US

IV. Provider business mailing address

62 SILVER PINE LN
DANVILLE CA
94506-4535
US

V. Phone/Fax

Practice location:
  • Phone: 925-335-6778
  • Fax:
Mailing address:
  • Phone: 925-216-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126085
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number126085
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number108521
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: