Provider Demographics
NPI:1316447451
Name:RYAN, CHRISTIE SUSAN (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:SUSAN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:SUSAN
Other - Last Name:FRAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13005 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3159
Mailing Address - Country:US
Mailing Address - Phone:360-609-9167
Mailing Address - Fax:
Practice Address - Street 1:13005 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-3159
Practice Address - Country:US
Practice Address - Phone:360-609-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60414139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health