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General NPI Number Information
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NPI Number | 1033398284
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Entity Type | Individual
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Provider Name | KEVIN THOMAS RYAN M.A., MFCT, LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 119 E 2ND ST STE 216
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City | THE DALLES
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State | OR
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Zip | 97058-1796
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Country | US
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Telephone | 541-296-6114
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Fax | 541-296-6577
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Provider Business Mailing Address
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Address Line | 119 E 2ND ST STE 216
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City | THE DALLES
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State | OR
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Zip | 97058-1796
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Country | US
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Telephone | 541-296-6114
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Fax | 541-296-6577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0405
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC31395
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License Number State | CA
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