Healthcare Provider Details

I. General information

NPI: 1063979193
Provider Name (Legal Business Name): RYAN PATRICK HORN MED, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

IV. Provider business mailing address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-5993
  • Fax: 567-560-5486
Mailing address:
  • Phone: 419-528-5993
  • Fax: 567-560-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1901746
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8380
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: