Provider Demographics
NPI:1073754982
Name:RYAN, MOIRA K (LPC)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:K
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 NW EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2654
Mailing Address - Country:US
Mailing Address - Phone:503-468-6998
Mailing Address - Fax:
Practice Address - Street 1:1355 NW EVERETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2654
Practice Address - Country:US
Practice Address - Phone:503-468-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011590101YM0800X, 101YM0800X
ORC7616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health