Healthcare Provider Details

I. General information

NPI: 1891334579
Provider Name (Legal Business Name): DOUGLAS RYDER IMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25111 COUNTRY CLUB BLVD STE 290
NORTH OLMSTED OH
44070-5330
US

IV. Provider business mailing address

25111 COUNTRY CLUB BLVD STE 290
NORTH OLMSTED OH
44070-5330
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 216-468-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2000154
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1900155-TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF.2300310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: