Healthcare Provider Details

I. General information

NPI: 1225968191
Provider Name (Legal Business Name): RYAN BUSBY LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK RD STE 601
LUTHERVILLE MD
21093-6034
US

IV. Provider business mailing address

3100 FALLSCLIFF RD APT 121
BALTIMORE MD
21211-2853
US

V. Phone/Fax

Practice location:
  • Phone: 667-220-0097
  • Fax:
Mailing address:
  • Phone: 914-374-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP17933
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: