Provider Demographics
NPI:1093952814
Name:RYAN, COLIN MCPHILLIPS (LPC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:MCPHILLIPS
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 W ROSCOE ST # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6209
Mailing Address - Country:US
Mailing Address - Phone:773-329-6968
Mailing Address - Fax:
Practice Address - Street 1:2213 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6209
Practice Address - Country:US
Practice Address - Phone:773-329-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005814390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program