Provider Demographics
NPI:1508296070
Name:NATHAN RYAN DEAN PHD LP PLLC
Entity Type:Organization
Organization Name:NATHAN RYAN DEAN PHD LP PLLC
Other - Org Name:RYAN DEAN PHD LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:651-231-9936
Mailing Address - Street 1:1599 SELBY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6218
Mailing Address - Country:US
Mailing Address - Phone:651-231-9936
Mailing Address - Fax:651-846-5784
Practice Address - Street 1:1599 SELBY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6218
Practice Address - Country:US
Practice Address - Phone:651-231-9936
Practice Address - Fax:651-846-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5397103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty