Provider Demographics
NPI:1639253040
Name:WITT, RYAN (LIMHP, LPC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:WITT
Suffix:
Gender:M
Credentials:LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 W 2ND ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5413
Mailing Address - Country:US
Mailing Address - Phone:308-675-2222
Mailing Address - Fax:308-675-2223
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-675-2222
Practice Address - Fax:308-675-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2141101YM0800X
NE95101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077707526Medicaid