=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689322414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYAN MATHER PSYD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2022
-----------------------------------------------------
Last Update Date | 10/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 N MICHIGAN AVE STE 1610
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-3653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-234-7509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6177 N LINCOLN AVE # 197
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60659-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. RYAN MATHER
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 773-234-7509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------