Provider Demographics
NPI:1376792622
Name:RYAN, ALISA JO (MSED, LMHP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:JO
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSED, LMHP
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:JO
Other - Last Name:EDGERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP
Mailing Address - Street 1:514 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-7336
Mailing Address - Country:US
Mailing Address - Phone:308-340-3038
Mailing Address - Fax:
Practice Address - Street 1:514 W 11TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-7336
Practice Address - Country:US
Practice Address - Phone:308-237-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8541101YM0800X
NE4262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health