MEDICARE: MR. CHRISTOPHER RYAN

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

General Provider Information

NPI Number	:	1710300322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER RYAN

Provider Business Mailing Address
First Line	:	715 SW RAMSEY AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97527-5500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4385 SUNNYVIEW ROAD NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305
Country	:	US
Telephone Number	:	707-208-2085
Fax Number	:

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

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	06/18/2015

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