MEDICARE: MR. RYAN WHITE LPC, LCMHC

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	20490	NC
2	101YP2500X	Professional Counselor	0701011316	VA

General Provider Information

NPI Number	:	1912720392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN WHITE LPC, LCMHC

Provider Business Mailing Address
First Line	:	1707 RICHMOND AVE
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4733
Country	:	US
Telephone Number	:	336-317-2473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 RICHMOND AVE
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-4733
Country	:	US
Telephone Number	:	336-317-2473
Fax Number	:

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

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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