MEDICARE: AMBER M. RYAN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	15227	FL
2	101YP2500X	Professional Counselor	MH18892	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18892	OTHER	FL	LMHC

General Provider Information

NPI Number	:	1144886680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER M. RYAN LMHC

Provider Business Mailing Address
First Line	:	1513 WALNUT AVE
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5614
Country	:	US
Telephone Number	:	863-840-2998
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 N RIDGEWOOD DR
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-7205
Country	:	US
Telephone Number	:	844-373-5762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	02/24/2021

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