Provider Demographics
NPI:1467018093
Name:HENRY, RYAN DOUGLAS (LPC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DOUGLAS
Last Name:HENRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1832
Mailing Address - Country:US
Mailing Address - Phone:814-871-5162
Mailing Address - Fax:
Practice Address - Street 1:2910 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1832
Practice Address - Country:US
Practice Address - Phone:814-871-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional