Provider Demographics
NPI:1114118148
Name:RYAN, EMILY (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 OLD SHELL RD STE B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3020
Mailing Address - Country:US
Mailing Address - Phone:251-431-2024
Mailing Address - Fax:
Practice Address - Street 1:2450 OLD SHELL RD STE B
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3020
Practice Address - Country:US
Practice Address - Phone:251-431-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
AL0773-1985C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical