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General NPI Number Information
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NPI Number | 1902684046
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Entity Type | Individual
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Provider Name | ROBERT RYAN
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Gender | Male
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE STE 206
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City | MISSOULA
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State | MT
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Zip | 59801-5670
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Country | US
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Telephone | 406-802-0704
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1031
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City | STEVENSVILLE
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State | MT
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Zip | 59870-1031
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Country | US
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Telephone | 406-802-0704
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-PCLC-LIC-44256
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License Number State | MT
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