Provider Demographics
NPI:1699170738
Name:VERA, RYAN (LCAC, LCPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:LCAC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 CLINTON PARKWAY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2627
Mailing Address - Country:US
Mailing Address - Phone:785-843-5483
Mailing Address - Fax:
Practice Address - Street 1:3205 CLINTON PARKWAY CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2627
Practice Address - Country:US
Practice Address - Phone:785-843-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00729101YA0400X
KS2869101YP2500X
TX17916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional