Provider Demographics
NPI:1003171984
Name:NEACE, RYAN THOMAS (MA, LPC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:NEACE
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 DEERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6457
Mailing Address - Country:US
Mailing Address - Phone:314-879-4255
Mailing Address - Fax:866-596-5017
Practice Address - Street 1:14650 DEERWOOD ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6457
Practice Address - Country:US
Practice Address - Phone:858-227-7719
Practice Address - Fax:866-596-5017
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005000101YP2500X
MO2013014281101YP2500X
CA10406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12399247OtherCAQH PROVIDER ID