Provider Demographics
NPI:1821665522
Name:RYAN, KEVIN E (MED LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:RYAN
Suffix:
Gender:M
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMPUTER RD STE C15
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1735
Mailing Address - Country:US
Mailing Address - Phone:484-440-9740
Mailing Address - Fax:
Practice Address - Street 1:2300 COMPUTER RD STE C15
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1735
Practice Address - Country:US
Practice Address - Phone:484-440-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013135101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty