Provider Demographics
NPI:1538599055
Name:LARK RYAN, LCSW, LLC
Entity type:Organization
Organization Name:LARK RYAN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARK
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-287-4975
Mailing Address - Street 1:1525 NE WEIDLER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1410
Mailing Address - Country:US
Mailing Address - Phone:503-994-9141
Mailing Address - Fax:971-232-3042
Practice Address - Street 1:1525 NE WEIDLER ST # 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1410
Practice Address - Country:US
Practice Address - Phone:503-994-9141
Practice Address - Fax:971-232-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL2683261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)