Provider Demographics
NPI:1629549548
Name:SNODGRASS, RYAN ILYSSE (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ILYSSE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 CITY LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2633
Mailing Address - Country:US
Mailing Address - Phone:562-200-2400
Mailing Address - Fax:
Practice Address - Street 1:9842 13TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-3171
Practice Address - Country:US
Practice Address - Phone:949-650-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114821101YM0800X
CA9247101YM0800X
CAAPCC4400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health