Provider Demographics
NPI:1750782934
Name:RYAN, ANDREA (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 CHATTAHOOCHEE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7776
Mailing Address - Country:US
Mailing Address - Phone:940-442-3101
Mailing Address - Fax:
Practice Address - Street 1:1142 CHATTAHOOCHEE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-7776
Practice Address - Country:US
Practice Address - Phone:940-442-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83457101YP2500X
TX70150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional