Healthcare Provider Details

I. General information

NPI: 1609248962
Provider Name (Legal Business Name): RYAN D VARGAS LMSW, CADC, CCAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 RIVERSIDE AVE STE 11
ADRIAN MI
49221-1465
US

IV. Provider business mailing address

770 RIVERSIDE AVE STE 11
ADRIAN MI
49221-1465
US

V. Phone/Fax

Practice location:
  • Phone: 517-264-2244
  • Fax: 517-263-3325
Mailing address:
  • Phone: 517-264-2244
  • Fax: 517-263-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-01111
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: