Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 6401013960 | MI |
N | 101YM0800X | Mental Health Counselor | 6401013960 | MI |
N | 101YP1600X | Pastoral Counselor | 6401013960 | MI |
Y | 101YP2500X | Professional Counselor | 6401013960 | MI |
NPI | 1073941985 |
---|---|
Provider Name | Ryan Hanberry |
First Address | Wyoming, MI 49519-4955 |
Second Address | Wyoming, MI 49519-4955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 31/10/2013 |