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NPI Code Detail

MEDICARE: MR. RYAN M. SELVIG MS, LPC, NCC.

MEDICARE: MR. RYAN M. SELVIG MS, LPC, NCC.
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
1101YP2500XProfessional CounselorLPC1256WY
2101YP2500XProfessional Counselor8858SC

General Provider Information

NPI Number : 1790070878
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN M. SELVIG MS, LPC, NCC.
Provider Business Mailing Address
First Line : 748 MAIN ST
Second Line :
City : LANDER
State : WY
Zip : 82520-3036
Country : US
Telephone Number : 307-332-2231
Fax Number : 307-332-9338
Provider Business Practice Location Address
First Line : 871 LOWCOUNTRY BLVD STE 200
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-3096
Country : US
Telephone Number : 843-501-1099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2011
Last Update Date : 06/13/2023

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