Provider Demographics
NPI:1285831065
Name:WINTERS, RYAN LANCE (BS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LANCE
Last Name:WINTERS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2274
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-2274
Mailing Address - Country:US
Mailing Address - Phone:580-436-3504
Mailing Address - Fax:580-436-5047
Practice Address - Street 1:605 E 12TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6605
Practice Address - Country:US
Practice Address - Phone:580-436-3504
Practice Address - Fax:580-436-5047
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor