Provider Demographics
NPI:1881921633
Name:STOUMBAUGH, RYAN J (LPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:STOUMBAUGH
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 1:2010 RIVER REACH DR
Mailing Address - Street 2:APT 173
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5247
Mailing Address - Country:US
Mailing Address - Phone:573-578-8289
Mailing Address - Fax:
Practice Address - Street 1:2010 RIVER REACH DR
Practice Address - Street 2:APT 173
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5247
Practice Address - Country:US
Practice Address - Phone:573-578-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009033692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional