Provider Demographics
NPI:1962574251
Name:RYAN, PATTI (LMFT)
Entity type:Individual
Prefix:MS
First Name:PATTI
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18205 N 51ST AVE STE 136
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1492
Mailing Address - Country:US
Mailing Address - Phone:623-399-2267
Mailing Address - Fax:866-340-1836
Practice Address - Street 1:18205 N 51ST AVE STE 136
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1492
Practice Address - Country:US
Practice Address - Phone:623-399-2267
Practice Address - Fax:866-340-1836
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMFT10234OtherTHERAPIST