Provider Demographics
NPI:1063990984
Name:RYAN EVANS COUNSELING, LLC
Entity type:Organization
Organization Name:RYAN EVANS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:402-330-1537
Mailing Address - Street 1:12728 AUGUSTA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3753
Mailing Address - Country:US
Mailing Address - Phone:402-330-1537
Mailing Address - Fax:402-330-9331
Practice Address - Street 1:12728 AUGUSTA AVE STE 150
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3753
Practice Address - Country:US
Practice Address - Phone:402-330-1537
Practice Address - Fax:402-330-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YP2500X
NE1189101YA0400X
NE1692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE600894738Medicaid