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General NPI Number Information
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NPI Number | 1699900746
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Entity Type | Individual
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Provider Name | RYAN DAVID LIBERATI LPC, LCPC, RPT
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 3115 S GRAND BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1046
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Country | US
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Telephone | 314-577-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 3115 S GRAND BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1046
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Country | US
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Telephone | 314-252-0683
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.006751
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2013030317
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License Number State | MO
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