Healthcare Provider Details

I. General information

NPI: 1346953338
Provider Name (Legal Business Name): ELIZABETH RYAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIBBY RYAN LPC

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 BONHOMME AVE STE 850
SAINT LOUIS MO
63105-1964
US

IV. Provider business mailing address

230 S BEMISTON AVE STE 1006
CLAYTON MO
63105-1907
US

V. Phone/Fax

Practice location:
  • Phone: 636-575-6560
  • Fax:
Mailing address:
  • Phone: 636-575-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026016954
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: