Provider Demographics
NPI:1285488007
Name:LEGAULT, RYAN JAMES
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAMES
Last Name:LEGAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 DOONE ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3512
Mailing Address - Country:US
Mailing Address - Phone:805-630-0175
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5726
Practice Address - Country:US
Practice Address - Phone:805-413-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical