MEDICARE: RYAN NOLAN BLOXHAM 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	LMHC10005171	MA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1730848508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN NOLAN BLOXHAM LMHC

Provider Business Mailing Address
First Line	:	575 BOYLSTON ST FL 2W
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3607
Country	:	US
Telephone Number	:	617-354-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 BOYLSTON ST FL 2W
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3607
Country	:	US
Telephone Number	:	617-354-4450
Fax Number	:

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

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	03/02/2026

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