Provider Demographics
NPI:1255027512
Name:RYAN, STACY L
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 INGOMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3661
Mailing Address - Country:US
Mailing Address - Phone:406-426-2828
Mailing Address - Fax:
Practice Address - Street 1:1405 INGOMAR BLVD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3661
Practice Address - Country:US
Practice Address - Phone:406-426-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LMFT-LIC-81403106H00000X
MT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist