Provider Demographics
NPI:1639418478
Name:RYDER, DENISE A (LMFT, LCAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:RYDER
Suffix:
Gender:F
Credentials:LMFT, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 NANCY LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4236
Mailing Address - Country:US
Mailing Address - Phone:317-881-1057
Mailing Address - Fax:
Practice Address - Street 1:96 NANCY LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4236
Practice Address - Country:US
Practice Address - Phone:317-881-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001063A101YA0400X
IN35000374A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)