Provider Demographics
NPI:1760181614
Name:RYAN, LUKE O'KEEFE (LAC)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:O'KEEFE
Last Name:RYAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N PRIEST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-1213
Mailing Address - Country:US
Mailing Address - Phone:833-719-0886
Mailing Address - Fax:
Practice Address - Street 1:1500 N PRIEST DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-1213
Practice Address - Country:US
Practice Address - Phone:833-719-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health