Provider Demographics
NPI:1710213186
Name:HOLLISTER, RYAN C (LPC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:HOLLISTER
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 1:700 NE MULTNOMAH ST STE 275
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4103
Mailing Address - Country:US
Mailing Address - Phone:503-729-1380
Mailing Address - Fax:503-841-6343
Practice Address - Street 1:700 NE MULTNOMAH ST STE 275
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4103
Practice Address - Country:US
Practice Address - Phone:503-729-1380
Practice Address - Fax:503-841-6343
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional