Healthcare Provider Details

I. General information

NPI: 1528204559
Provider Name (Legal Business Name): RYAN LUTHER BUHITE PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S 15TH ST STE 1550 PMB 704308
PHILADELPHIA PA
19102-4806
US

IV. Provider business mailing address

30 S 15TH ST STE 1550 PMB 704308
PHILADELPHIA PA
19102-4806
US

V. Phone/Fax

Practice location:
  • Phone: 814-771-0386
  • Fax:
Mailing address:
  • Phone: 814-771-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS 016-556
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: