Healthcare Provider Details

I. General information

NPI: 1104742436
Provider Name (Legal Business Name): RYAN SKYE ROSS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 CANDELARIA RD NE
ALBUQUERQUE NM
87112-1401
US

IV. Provider business mailing address

9741 CANDELARIA RD NE
ALBUQUERQUE NM
87112-1401
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-3573
  • Fax:
Mailing address:
  • Phone: 505-291-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: