Provider Demographics
NPI:1740687276
Name:RYAN, REBECCA J (LPC, LMHC, LIMHP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC, LMHC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0472
Mailing Address - Country:US
Mailing Address - Phone:214-498-3210
Mailing Address - Fax:
Practice Address - Street 1:4144 N CENTRAL EXPY STE 600-33
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3140
Practice Address - Country:US
Practice Address - Phone:214-498-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1121101YM0800X
NE4416101YM0800X
IA129714101YP2500X
TX76037101YP2500X
NE1350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health