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NPI Code Detail

MEDICARE: DR. RYAN DAVID LIBERATI LPC, LCPC, RPT

MEDICARE: DR. RYAN DAVID LIBERATI LPC, LCPC, RPT
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
1101YP2500XProfessional Counselor178.006751IL
2101YP2500XProfessional Counselor2013030317MO

General Provider Information

NPI Number : 1699900746
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN DAVID LIBERATI LPC, LCPC, RPT
Provider Business Mailing Address
First Line : 3115 S GRAND BLVD STE 300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1046
Country : US
Telephone Number : 314-252-0683
Fax Number :
Provider Business Practice Location Address
First Line : 3115 S GRAND BLVD STE 300
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1046
Country : US
Telephone Number : 314-577-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2009
Last Update Date : 10/25/2022

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