Provider Demographics
NPI:1770156168
Name:GARRISON, RYAN JEFFREY (LPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JEFFREY
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4354
Mailing Address - Country:US
Mailing Address - Phone:215-870-0339
Mailing Address - Fax:
Practice Address - Street 1:28 FARMBROOK DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2101
Practice Address - Country:US
Practice Address - Phone:215-870-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional