MEDICARE: RACHELLE L. RYAN MA, NCC, 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	180008806	IL
2	101YP2500X	Professional Counselor	76664	TX

General Provider Information

NPI Number	:	1871813311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE L. RYAN MA, NCC, LPC

Provider Business Mailing Address
First Line	:	5801 MARVIN D LOVE FWY STE 218
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2300
Country	:	US
Telephone Number	:	713-865-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 MARVIN D LOVE FWY STE 218
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-2300
Country	:	US
Telephone Number	:	713-865-6585
Fax Number	:

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	07/24/2023

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Directions to “ RACHELLE L. RYAN MA, NCC, LPC” Practice Location

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