Provider Demographics
NPI:1578879631
Name:RYAN, THOMAS PETER (LCSW, MAC, CDCII)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PETER
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCSW, MAC, CDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8121
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-225-2230
Mailing Address - Fax:907-225-2230
Practice Address - Street 1:320 BAWDEN ST. #318
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-225-2230
Practice Address - Fax:907-225-2230
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical