Provider Demographics
NPI:1811063845
Name:SMITH, RYAN S (MED, LMFT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 COUNTRY CLUB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2272
Mailing Address - Country:US
Mailing Address - Phone:541-604-8822
Mailing Address - Fax:
Practice Address - Street 1:927 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2272
Practice Address - Country:US
Practice Address - Phone:929-464-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist