Provider Demographics
NPI:1861237422
Name:FOCKLER, RYAN (MA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FOCKLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2735
Mailing Address - Country:US
Mailing Address - Phone:775-636-4357
Mailing Address - Fax:
Practice Address - Street 1:8255 OPAL RANCH WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-7789
Practice Address - Country:US
Practice Address - Phone:775-362-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health