Provider Demographics
NPI:1679338461
Name:O'KELLY, RYAN G (LPC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:O'KELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 WOODSTOCK PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4869
Mailing Address - Country:US
Mailing Address - Phone:678-653-3272
Mailing Address - Fax:
Practice Address - Street 1:970 WOODSTOCK PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4869
Practice Address - Country:US
Practice Address - Phone:678-653-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional