Basic Information
| Provider Information | |||||||||
| NPI: | 1891235784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN PELT | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BETHEL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144593003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1375 US HIGHWAY 42 SE STE C | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431409548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408458652 | ||||||||
| FaxNumber: | 6145030899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1300193 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.