Provider Demographics
NPI:1316268113
Name:STIVERS, RYAN JOSEPH (PHD, LMFT, LPC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:STIVERS
Suffix:
Gender:M
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10286
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-0286
Mailing Address - Country:US
Mailing Address - Phone:309-713-1485
Mailing Address - Fax:
Practice Address - Street 1:1717 W CANDLETREE DR
Practice Address - Street 2:STE. B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1592
Practice Address - Country:US
Practice Address - Phone:309-713-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1111086101YP2500X
ARM1206007106H00000X
IL166001032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR182287795Medicaid