Provider Demographics
NPI:1194351775
Name:GANTER, RYAN (LPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GANTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3006
Mailing Address - Country:US
Mailing Address - Phone:724-766-3825
Mailing Address - Fax:
Practice Address - Street 1:144 EMERYVILLE DR STE 120
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5015
Practice Address - Country:US
Practice Address - Phone:412-921-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional