Provider Demographics
NPI:1912323221
Name:RYAN SMITH COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:RYAN SMITH COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LIMHP, LADC
Authorized Official - Phone:308-455-3435
Mailing Address - Street 1:3000 2ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-3507
Mailing Address - Country:US
Mailing Address - Phone:308-455-3435
Mailing Address - Fax:308-455-3437
Practice Address - Street 1:3000 2ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3507
Practice Address - Country:US
Practice Address - Phone:308-455-3435
Practice Address - Fax:308-455-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1048101YA0400X
NE1030101YM0800X
NE1728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025564200Medicaid