Provider Demographics
NPI:1407977697
Name:RYLAND, LORI ANN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:RYLAND
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:23517 N ULDRIKS DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9027
Mailing Address - Country:US
Mailing Address - Phone:269-838-6749
Mailing Address - Fax:269-979-9728
Practice Address - Street 1:140 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3602
Practice Address - Country:US
Practice Address - Phone:269-979-9132
Practice Address - Fax:269-979-9728
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010239103T00000X, 103TA0400X, 103TC0700X, 103TC2200X, 103TP2701X
MI1-12-11395103K00000X
6301010239103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral