Provider Demographics
NPI:1740781384
Name:MCDOUGLE, RYAN RICHARD (MA, QMHP)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:RICHARD
Last Name:MCDOUGLE
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S G ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-1817
Mailing Address - Country:US
Mailing Address - Phone:541-947-6021
Mailing Address - Fax:541-219-8114
Practice Address - Street 1:35 S G ST
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-1817
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:541-219-8114
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator