Provider Demographics
NPI:1063791812
Name:LANSDELL, RYAN (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LANSDELL
Suffix:
Gender:M
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SHELLEY DR STE 2G
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2530
Mailing Address - Country:US
Mailing Address - Phone:201-841-0777
Mailing Address - Fax:
Practice Address - Street 1:121 SHELLEY DR STE 2G
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:201-841-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00175900101YA0400X
NJ37PC00699600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)