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General NPI Number Information
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NPI Number | 1629946058
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Entity Type | Individual
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Provider Name | RYAN TUSTIN
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Gender | Male
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL STE 300
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City | VANCOUVER
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State | WA
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Zip | 98683-5509
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Country | US
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Telephone | 360-619-2226
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Fax | 360-326-9691
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Provider Business Mailing Address
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Address Line | 625 SE 16TH AVE APT 2
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City | PORTLAND
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State | OR
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Zip | 97214-2615
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Country | US
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Telephone | 360-619-2226
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Fax | 360-326-9691
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC70026234
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License Number State | WA
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