Provider Demographics
NPI:1255813135
Name:NORTON, RYAN (MA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:NORTON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1139
Mailing Address - Country:US
Mailing Address - Phone:406-829-3499
Mailing Address - Fax:
Practice Address - Street 1:2825 STOCKYARD RD STE A11
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1544
Practice Address - Country:US
Practice Address - Phone:406-543-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health