Provider Demographics
NPI:1790401545
Name:ELKINS, RYAN CLEDITH (PRSS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CLEDITH
Last Name:ELKINS
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 UPPER MUD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506-9521
Mailing Address - Country:US
Mailing Address - Phone:740-744-5436
Mailing Address - Fax:
Practice Address - Street 1:1842 10TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3712
Practice Address - Country:US
Practice Address - Phone:740-744-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)