Provider Demographics
NPI:1972139947
Name:KEVIN RYAN PC
Entity type:Organization
Organization Name:KEVIN RYAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR / PRACTIONEER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-296-6114
Mailing Address - Street 1:119 E 2ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1796
Mailing Address - Country:US
Mailing Address - Phone:541-340-0402
Mailing Address - Fax:541-296-6577
Practice Address - Street 1:119 E 2ND ST STE 210
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1796
Practice Address - Country:US
Practice Address - Phone:541-296-6114
Practice Address - Fax:541-296-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT1402OtherOREGON LICENSE