Provider Demographics
NPI:1710285093
Name:MEBUST, RYAN (IMFT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:MEBUST
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 WOODMAN CENTER CT
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1477
Mailing Address - Country:US
Mailing Address - Phone:937-439-0505
Mailing Address - Fax:937-293-0650
Practice Address - Street 1:2670 WOODMAN CENTER CT
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1477
Practice Address - Country:US
Practice Address - Phone:937-439-0505
Practice Address - Fax:937-293-0650
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1100002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist