Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003246935 |
---|---|
Provider Name | Colin Ryan |
First Address | Toledo, OR 97391-1613 |
Second Address | Toledo, OR 97391-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 13/11/2013 |