Healthcare Provider Details

I. General information

NPI: 1013920412
Provider Name (Legal Business Name): RYAN R LINDSAY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 LINDELL BLVD STE 200
SAINT LOUIS MO
63108-2948
US

IV. Provider business mailing address

4236 LINDELL BLVD STE 200
SAINT LOUIS MO
63108-2948
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1155
  • Fax: 314-531-1170
Mailing address:
  • Phone: 314-531-1155
  • Fax: 314-531-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801085563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: