Provider Demographics
NPI:1184372807
Name:MISEGADIS, RYAN J (LPCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:MISEGADIS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 24TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3114
Mailing Address - Country:US
Mailing Address - Phone:720-319-7322
Mailing Address - Fax:
Practice Address - Street 1:3035 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4635
Practice Address - Country:US
Practice Address - Phone:720-319-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health