Provider Demographics
NPI:1720598485
Name:HOLLEY, RYAN JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E WOODFIELD RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5170
Mailing Address - Country:US
Mailing Address - Phone:630-216-9416
Mailing Address - Fax:
Practice Address - Street 1:1701 E WOODFIELD RD STE 305
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5170
Practice Address - Country:US
Practice Address - Phone:630-216-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty