Provider Demographics
NPI:1619180593
Name:RYAN, STEPHEN O (LMHC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:O
Last Name:RYAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 METROWEST BLVD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3289
Mailing Address - Country:US
Mailing Address - Phone:407-730-3837
Mailing Address - Fax:407-730-3869
Practice Address - Street 1:6150 METROWEST BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3289
Practice Address - Country:US
Practice Address - Phone:407-730-3837
Practice Address - Fax:407-730-3869
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273239OtherWELLCARE PROVIDER NUMBER
FL277791OtherAMERIGROUP MEDICAID HMO
FL1851663496OtherGROUP NPI
FL1628174OtherCIGNA PROVIDER #