Provider Demographics
NPI:1891092888
Name:RYAN, DIANA FAYE (MSBS)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:FAYE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3709
Mailing Address - Country:US
Mailing Address - Phone:580-482-6296
Mailing Address - Fax:
Practice Address - Street 1:319 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3709
Practice Address - Country:US
Practice Address - Phone:580-482-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor