Provider Demographics
NPI:1487521704
Name:RYAN LARSEN PSYCHOTHERPAY
Entity type:Organization
Organization Name:RYAN LARSEN PSYCHOTHERPAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-227-7338
Mailing Address - Street 1:18103 44TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4601
Mailing Address - Country:US
Mailing Address - Phone:206-227-7338
Mailing Address - Fax:
Practice Address - Street 1:18103 44TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4601
Practice Address - Country:US
Practice Address - Phone:206-227-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty