MEDICARE: JACOB RYAN WALTRIP

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		CA

General Provider Information

NPI Number	:	1831027572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB RYAN WALTRIP

Provider Business Mailing Address
First Line	:	2368 SAUSALITO ST
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95928-9415
Country	:	US
Telephone Number	:	530-433-9249
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 RIO LINDO AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-1817
Country	:	US
Telephone Number	:	530-345-3491
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/14/2026

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Directions to “ JACOB RYAN WALTRIP ” Practice Location

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