Provider Demographics
NPI:1861218331
Name:RYAN, DENNIS MARTIN (LPC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MARTIN
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 N 32ND ST STE J
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4765
Mailing Address - Country:US
Mailing Address - Phone:602-348-5667
Mailing Address - Fax:
Practice Address - Street 1:4202 N 32ND ST STE J
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4765
Practice Address - Country:US
Practice Address - Phone:602-348-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1243103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty