Provider Demographics
NPI:1093609430
Name:MCKINLEY, RYAN AARON (LPC015641)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:AARON
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:LPC015641
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 ANTILLES DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4784
Mailing Address - Country:US
Mailing Address - Phone:706-364-7165
Mailing Address - Fax:
Practice Address - Street 1:103 ROSSMORE PL
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5769
Practice Address - Country:US
Practice Address - Phone:706-364-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health