Provider Demographics
NPI:1801002514
Name:SMITH, RYAN PATRICK (LIMHP, CPC, LADC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:LIMHP, CPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 2ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3507
Mailing Address - Country:US
Mailing Address - Phone:308-455-3435
Mailing Address - Fax:308-455-3437
Practice Address - Street 1:3000 2ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3507
Practice Address - Country:US
Practice Address - Phone:308-455-3435
Practice Address - Fax:308-455-3437
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829226Medicaid