MEDICARE: LISA LASHONNE RYAN RAS, CATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	169643	CA

General Provider Information

NPI Number	:	1588185441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LASHONNE RYAN RAS, CATC

Provider Business Mailing Address
First Line	:	320 AVALON CIR
Second Line	:
City	:	PITTSBURG
State	:	CA
Zip	:	94565-2330
Country	:	US
Telephone Number	:	510-677-8958
Fax Number	:	510-839-6775

Provider Business Practice Location Address
First Line	:	2811 ADELINE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94608-4409
Country	:	US
Telephone Number	:	510-874-7850
Fax Number	:	510-839-6775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	06/30/2017

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