Provider Demographics
NPI:1346534682
Name:RYAN, LINDA JOHNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOHNETTE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5219
Mailing Address - Country:US
Mailing Address - Phone:713-306-5750
Mailing Address - Fax:
Practice Address - Street 1:1119 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5219
Practice Address - Country:US
Practice Address - Phone:713-306-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical