Healthcare Provider Details

I. General information

NPI: 1356102586
Provider Name (Legal Business Name): RYAN K. AYERS LCSW, CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RYAN KENT LCSW, CST

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5294 MADISON PIKE STE 202
INDEPENDENCE KY
41051-7971
US

IV. Provider business mailing address

5294 MADISON PIKE STE 202
INDEPENDENCE KY
41051-7971
US

V. Phone/Fax

Practice location:
  • Phone: 859-955-8852
  • Fax:
Mailing address:
  • Phone: 859-955-8852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019885
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: