MEDICARE: RYAN GOLDMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC 15898

General Provider Information

NPI Number	:	1710350442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN GOLDMAN LPC

Provider Business Mailing Address
First Line	:	16017 S 45TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 N 99TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5466
Country	:	US
Telephone Number	:	623-977-8373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	12/12/2015

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Directions to “ RYAN GOLDMAN LPC” Practice Location

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