Provider Demographics
NPI:1780089409
Name:RYAN, GEORGE TERRENCE (LMHC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:TERRENCE
Last Name:RYAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-9797
Mailing Address - Country:US
Mailing Address - Phone:518-420-5097
Mailing Address - Fax:
Practice Address - Street 1:39 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2801
Practice Address - Country:US
Practice Address - Phone:518-536-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003167-1101YM0800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool