Individual provider Active NPI

Ryan Brown

  • Marriage & Family Therapist
  • Commerce, CA
National Provider Identifier
1811396880
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
103389 Issued in CA
Practice address
5628 E Slauson Ave
Commerce, CA 90040-2922
Phone
(323) 480-9251
NPI assigned
Aug 15, 2014
Reactivated
Jul 26, 2021
Last updated
Jul 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 103389 CA Primary

Addresses

Primary practice location

5628 E Slauson Ave
Commerce, CA 90040-2922

Mailing address

5628 E Slauson Ave
Commerce, CA 90040-2922
Phone (323) 318-9960

Other practice location 1

9650 Zelzah Ave
Northridge, CA 91325-2003
Phone (818) 993-9311

Other identifiers 1

IdentifierTypeStateIssuer
95-2633765OtherCAMEDI-CAL

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

LicenseStateTypeSpecialty
103389CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Andrea Davis, PH.D., Clinical Psychology, Inc. Marriage & Family Therapist Current Accepting new patients
Penny Lane Centers PastSince Aug 6, 2019 Accepting new patients

Locations

913 E Walnut St
Pasadena, CA 91106
Phone (626) 225-2510

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1811396880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5628 E SLAUSON AVE",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900402922",
            "telephone_number": "323-318-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5628 E SLAUSON AVE",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900402922",
            "telephone_number": "323-480-9251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9650 Zelzah Ave",
            "address_purpose": "LOCATION",
            "city": "Northridge",
            "state": "CA",
            "postal_code": "913252003",
            "country_code": "US",
            "telephone_number": "818-993-9311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "RYAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-15",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "deactivation_date": "2021-06-09",
        "reactivation_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "103389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "95-2633765",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Commerce, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.