MEDICARE: ANGELA MARIE RYAN CRC

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	225C00000X	Rehabilitation Counselor	84264	TX

General Provider Information

NPI Number	:	1255659991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE RYAN CRC

Provider Business Mailing Address
First Line	:	4106 TWIN DR E
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-3104
Country	:	US
Telephone Number	:	409-457-0778
Fax Number	:

Provider Business Practice Location Address
First Line	:	4106 TWIN DR E
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-3104
Country	:	US
Telephone Number	:	409-457-0778
Fax Number	:

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	07/20/2010

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