Provider Demographics
NPI:1881013274
Name:GANO, RYAN W (LMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:GANO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 761943
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-6943
Mailing Address - Country:US
Mailing Address - Phone:210-646-1679
Mailing Address - Fax:
Practice Address - Street 1:4230 GARDENDALE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3475
Practice Address - Country:US
Practice Address - Phone:210-646-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist