Active NPI
Ryan Jibson, MSW
- Marriage & Family Therapist
- Roseville, CA
National Provider Identifier
1043775109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 81767
- Practice address
- 420 Folsom Rd Ste D
Roseville, CA 95678-2767 - Phone
- (916) 990-7131
- NPI assigned
- Feb 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 81767 | CA | Primary |
| Mental Health Counselor | 101YM0800X | 81767 | CA |
Addresses
Primary practice location
420 Folsom Rd Ste D
Roseville, CA 95678-2767
Mailing address
9809 Valley Pines Dr
Folsom, CA 95630-1933
Phone (916) 990-7131
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81767 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549238400000",
"number": "1043775109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9809 VALLEY PINES DR",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956301933",
"telephone_number": "916-990-7131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 FOLSOM RD STE D",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956782767",
"telephone_number": "916-990-7131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIBSON",
"first_name": "RYAN",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-04",
"last_updated": "2019-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "81767",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "81767",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.