Provider Demographics
NPI:1194758961
Name:RIFE, RYAN D (LCSW)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:D
Last Name:RIFE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-1725
Mailing Address - Country:US
Mailing Address - Phone:225-621-5770
Mailing Address - Fax:225-644-3208
Practice Address - Street 1:1112 E ASCENSION COMPLEX BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4265
Practice Address - Country:US
Practice Address - Phone:225-621-5770
Practice Address - Fax:225-644-3208
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1439983Medicaid
LA1439983Medicaid