Provider Demographics
NPI:1679512008
Name:RYAN, ED (LCPC)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N 27TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0101
Mailing Address - Country:US
Mailing Address - Phone:406-237-3585
Mailing Address - Fax:406-237-3586
Practice Address - Street 1:1101 N 27TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0101
Practice Address - Country:US
Practice Address - Phone:406-237-3585
Practice Address - Fax:406-237-3586
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT94101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional