Basic Information
| Provider Information | |||||||||
| NPI: | 1487799680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'RYAN | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5736 PINE TREE ST W | ||||||||
| Address2: | UNIT G | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144309756 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 BETHEL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145380353 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | C0008358 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.