Provider Demographics
NPI:1407610652
Name:BEAN, RYAN MARCUS (CO61160721)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARCUS
Last Name:BEAN
Suffix:
Gender:M
Credentials:CO61160721
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21130 78TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7141
Mailing Address - Country:US
Mailing Address - Phone:206-712-8109
Mailing Address - Fax:
Practice Address - Street 1:2133 3RD AVE STE 116
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2353
Practice Address - Country:US
Practice Address - Phone:206-432-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61160721101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor