Provider Demographics
NPI:1356984892
Name:RYAN, JULIE A (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2835 AL LIPSCOMB WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-1647
Mailing Address - Country:US
Mailing Address - Phone:972-817-6019
Mailing Address - Fax:
Practice Address - Street 1:2835 AL LIPSCOMB WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-1647
Practice Address - Country:US
Practice Address - Phone:972-817-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62595101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor