Healthcare Provider Details

I. General information

NPI: 1043894256
Provider Name (Legal Business Name): RYAN KOPYAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 17TH AVE NW STE 1557
SEATTLE WA
98107-5232
US

IV. Provider business mailing address

PO BOX 2569
EVERETT WA
98213-0569
US

V. Phone/Fax

Practice location:
  • Phone: 973-224-8171
  • Fax:
Mailing address:
  • Phone: 425-212-4200
  • Fax: 425-212-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: