Provider Demographics
NPI:1063979193
Name:HORN, RYAN PATRICK (MED, LPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:HORN
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3706
Mailing Address - Country:US
Mailing Address - Phone:419-528-5993
Mailing Address - Fax:567-560-5486
Practice Address - Street 1:680 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3706
Practice Address - Country:US
Practice Address - Phone:419-528-5993
Practice Address - Fax:567-560-5486
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC.1901746101YM0800X
SC8380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health