Provider Demographics
NPI:1093286924
Name:ORRISON, RYAN RICHARD (CDP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:RICHARD
Last Name:ORRISON
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NE GILMAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2941
Mailing Address - Country:US
Mailing Address - Phone:425-200-1074
Mailing Address - Fax:425-392-1792
Practice Address - Street 1:300 NE GILMAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2941
Practice Address - Country:US
Practice Address - Phone:425-200-1074
Practice Address - Fax:425-392-1792
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60777241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)