Provider Demographics
NPI:1942776612
Name:LISTBERGER, RYAN ANDREW (AMFT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:LISTBERGER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARKSHORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:916-459-8854
Mailing Address - Fax:916-404-5622
Practice Address - Street 1:101 PARKSHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:916-459-8854
Practice Address - Fax:916-404-5622
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA155564OtherBOARD OF BEHAVIORAL SCIENCES AMFT #