Healthcare Provider Details

I. General information

NPI: 1972088110
Provider Name (Legal Business Name): RYAN STUART PRICE MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21850 HIGHWAY 62 # 200
SHADY COVE OR
97539-8715
US

IV. Provider business mailing address

128 W ANTLER AVE
REDMOND OR
97756-1852
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-2105
  • Fax:
Mailing address:
  • Phone: 541-241-2105
  • Fax: 458-256-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC6051
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-23107
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: