Provider Demographics
NPI:1336847458
Name:ROBERTSON, RYAN FP (MS, TLPC-MHSP, NCC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:FP
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MS, TLPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 STONECREST PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6897
Mailing Address - Country:US
Mailing Address - Phone:615-247-6831
Mailing Address - Fax:615-713-3439
Practice Address - Street 1:521 STONECREST PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6897
Practice Address - Country:US
Practice Address - Phone:615-247-6831
Practice Address - Fax:615-713-3439
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7752101YP2500X, 101YM0800X
TN106S00000X, 175T00000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNY3C9X7P3OtherNATIONAL HEALTHCARE ASSOCIATION (NHA)
TN112481808OtherAMERICAN ASSOCIATION OF CHRISTIAN COUNSELORS (AACC)
TN000-2OtherTENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES (TDMHSAS)
TNRBT-22-222937OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)
TN000-1960OtherTENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES (TDMHSAS)