Provider Demographics
NPI:1538392105
Name:CARRUTHERS, RYAN PAUL (MHR, LADC, PLMHP)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PAUL
Last Name:CARRUTHERS
Suffix:
Gender:M
Credentials:MHR, LADC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 S 131ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1822
Mailing Address - Country:US
Mailing Address - Phone:402-933-1504
Mailing Address - Fax:402-933-1805
Practice Address - Street 1:4730 S 131ST ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1822
Practice Address - Country:US
Practice Address - Phone:402-933-1504
Practice Address - Fax:402-933-1805
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE801101YA0400X
NE9267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health