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General NPI Number Information
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NPI Number | 1477911360
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Entity Type | Individual
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Provider Name | HEATHER RYAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 8506 SIX FORKS RD STE 104
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City | RALEIGH
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State | NC
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Zip | 27615-3260
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Country | US
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Telephone | 919-234-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 438 BROOK PINE TRL
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City | APEX
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State | NC
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Zip | 27523-7149
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6367
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License Number State | NC
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