Healthcare Provider Details

I. General information

NPI: 1871550434
Provider Name (Legal Business Name): RICHARD C RYNEARSON PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 DARROW RD SUITE 101
STOW OH
44224-1411
US

IV. Provider business mailing address

4833 DARROW RD STE 101
STOW OH
44224-1411
US

V. Phone/Fax

Practice location:
  • Phone: 330-650-5338
  • Fax: 330-342-3837
Mailing address:
  • Phone: 330-650-5338
  • Fax: 330-342-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number758
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number758
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number758
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number758
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number758
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number758
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number758
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number758
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number758
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: