1376792622 NPI number — ALISA JO RYAN M.S.ED., LMHP

NPI Number: 1376792622
Health Care Provider/Practitioner: ALISA JO RYAN M.S.ED., LMHP

NPI Number : 1376792622 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376792622",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RYAN",
    "FirstName": "ALISA",
    "MiddleName": "JO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S.ED., LMHP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EDGERTON",
    "OtherFirstName": "ALISA",
    "OtherMiddleName": "JO",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMHP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "514 W 11TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KEARNEY",
    "MailingAddressStateName": "NE",
    "MailingAddressPostalCode": "68845-7336",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "308-340-3038",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "514 W 11TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KEARNEY",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68845-7336",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "308-237-4085",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/11/2008",
    "LastUpdateDate": "10/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "8541",
          "LicenseNumberStateCode": "NE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "4262",
          "LicenseNumberStateCode": "NE",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}