Healthcare Provider Details

I. General information

NPI: 1619180593
Provider Name (Legal Business Name): STEPHEN O RYAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 METROWEST BLVD SUITE # 103
ORLANDO FL
32835-3289
US

IV. Provider business mailing address

6150 METROWEST BLVD SUITE # 103
ORLANDO FL
32835-3289
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3837
  • Fax: 407-730-3869
Mailing address:
  • Phone: 407-730-3837
  • Fax: 407-730-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 7827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: