Provider Demographics
NPI:1689032682
Name:RYAN, MELISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
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:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:CROSSWICKS
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-0076
Mailing Address - Country:US
Mailing Address - Phone:609-351-1823
Mailing Address - Fax:
Practice Address - Street 1:20000 HORIZON WAY STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4303
Practice Address - Country:US
Practice Address - Phone:609-351-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00298100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional