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General NPI Number Information
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NPI Number | 1447627799
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Entity Type | Individual
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Provider Name | RYAN CHRISTOPHER BETHEM LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 530 BUSH ST FLOOR #7
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-3623
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Country | US
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Telephone | 415-553-5524
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Fax |
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Provider Business Mailing Address
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Address Line | 1381 S VAN NESS AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4017
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Country | US
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Telephone | 916-296-2613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 88478
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License Number State | CA
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