Healthcare Provider Details

I. General information

NPI: 1851680433
Provider Name (Legal Business Name): RYAN PATRICK MCMAHAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 COLONY DR
ADA OK
74820-2297
US

IV. Provider business mailing address

1300 HOPPE BLVD STE 1
ADA OK
74820-2319
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-1222
  • Fax: 580-272-5757
Mailing address:
  • Phone: 580-436-7206
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0019778
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6393
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: