Active NPI
Bryan Van Ravenhorst
- Mental Health Counselor
- Fresno, CA
National Provider Identifier
1609545284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 105285
- Practice address
- 1141 W Shaw Ave Ste 203
Fresno, CA 93711-3713 - Phone
- (559) 428-3137
- NPI assigned
- Sep 8, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 105285 | CA | Primary |
Addresses
Primary practice location
1141 W Shaw Ave Ste 203
Fresno, CA 93711-3713
Mailing address
PO Box 26813
Fresno, CA 93729-6813
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 |
|---|---|---|---|
| 105285 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692835200000",
"number": "1609545284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26813",
"city": "FRESNO",
"state": "CA",
"postal_code": "937296813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 W SHAW AVE STE 203",
"city": "FRESNO",
"state": "CA",
"postal_code": "937113713",
"telephone_number": "559-428-3137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN RAVENHORST",
"first_name": "BRYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-08",
"last_updated": "2023-08-24",
"certification_date": "2023-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "105285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.