Healthcare Provider Details

I. General information

NPI: 1902734494
Provider Name (Legal Business Name): LAURA LEE RYAN MS, LCAC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E WASHINGTON ST
INDIANAPOLIS IN
46201-3847
US

IV. Provider business mailing address

1420 E WASHINGTON ST
INDIANAPOLIS IN
46201-3847
US

V. Phone/Fax

Practice location:
  • Phone: 317-632-0123
  • Fax: 317-423-0608
Mailing address:
  • Phone: 317-632-0123
  • Fax: 317-423-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number86900026A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: