Provider Demographics
NPI:1760019020
Name:TAYLOR, RYAN (LCP, CRC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCP, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 PETERS PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-1714
Mailing Address - Country:US
Mailing Address - Phone:903-903-9961
Mailing Address - Fax:
Practice Address - Street 1:305 PUBLIC SQ STE 2
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3894
Practice Address - Country:US
Practice Address - Phone:903-756-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor