Provider Demographics
NPI:1609248962
Name:VARGAS, RYAN D (LMSW, CADC, CCAR)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:VARGAS
Suffix:
Gender:M
Credentials:LMSW, CADC, CCAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 RIVERSIDE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1465
Mailing Address - Country:US
Mailing Address - Phone:517-264-2244
Mailing Address - Fax:517-263-3325
Practice Address - Street 1:770 RIVERSIDE AVE STE 11
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1465
Practice Address - Country:US
Practice Address - Phone:517-264-2244
Practice Address - Fax:517-263-3325
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01111101YA0400X
171M00000X, 175T00000X
MI68011141031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist