Basic Information
| Provider Information | |||||||||
| NPI: | 1073941985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANBERRY | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1843 RW BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1843 RW BERENDS DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495194955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167732908 | ||||||||
| FaxNumber: | 6165323046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2013 | ||||||||
| LastUpdateDate: | 10/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401013960 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 6401013960 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP1600X | 6401013960 | MI | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YP2500X | 6401013960 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.