Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 84264 | TX |
NPI | 1255659991 |
---|---|
Provider Name | Angela Marie Ryan |
First Address | Santa Fe, TX 77510-3104 |
Second Address | Santa Fe, TX 77510-3104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2010 |
Last Update Date | 20/07/2010 |