Provider Demographics
NPI:1477281384
Name:RYAN, JAMES M (LCPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 DICKINSON CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1451
Mailing Address - Country:US
Mailing Address - Phone:410-446-7374
Mailing Address - Fax:
Practice Address - Street 1:1343 DICKINSON CT
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1451
Practice Address - Country:US
Practice Address - Phone:410-446-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
88-3622072OtherIRS