1578879631 NPI number — THOMAS PETER RYAN LCSW, MAC, CDCII

Table of content: THOMAS PETER RYAN LCSW, MAC, CDCII (NPI 1578879631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578879631 NPI number — THOMAS PETER RYAN LCSW, MAC, CDCII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYAN
Provider First Name:
THOMAS
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MAC, CDCII
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578879631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETCHIKAN
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-225-2230
Provider Business Mailing Address Fax Number:
907-225-2230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 BAWDEN ST. #318
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-225-2230
Provider Business Practice Location Address Fax Number:
907-225-2230
Provider Enumeration Date:
08/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  907 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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