Healthcare Provider Details

I. General information

NPI: 1639095771
Provider Name (Legal Business Name): RYAN R. EMRY M.ED., M.A., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2983 W GINGER GOLD DR
KUNA ID
83634-5303
US

IV. Provider business mailing address

2983 W GINGER GOLD DR
KUNA ID
83634-5303
US

V. Phone/Fax

Practice location:
  • Phone: 208-991-0009
  • Fax:
Mailing address:
  • Phone: 208-991-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4481611
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: