Provider Demographics
NPI:1952477606
Name:RYAN, BERNADETTE MARY (MA LLP LPC)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:MARY
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA LLP LPC
Other - Prefix:MS
Other - First Name:BERNADETTE
Other - Middle Name:MARY
Other - Last Name:CHLOPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LLP LPC
Mailing Address - Street 1:1148 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-726-2299
Mailing Address - Fax:231-728-6345
Practice Address - Street 1:1148 FOURTH ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-726-2299
Practice Address - Fax:231-728-6345
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005500101YP2500X
MI6301010268103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI120567OtherVALUE OPTIONS