Provider Demographics
NPI:1356922512
Name:KING, RYAN JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TALLY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2937
Mailing Address - Country:US
Mailing Address - Phone:412-715-9817
Mailing Address - Fax:
Practice Address - Street 1:1386 OLD FREEPORT RD STE 1AF
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3115
Practice Address - Country:US
Practice Address - Phone:412-254-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW021749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional