Ryan Lee Blackstock, PSY.D., LP – Psychologist

Key facts

NPI: 1104014273
Entity type: Individual (NPI type 1)
Primary specialty: Psychologist 103T00000X
License: 6301013412 (MI)
Practice address: 19366 Allen Rd
Suite C
Brownstown TWP, MI 48183-6809
Phone: (734) 479-0949
Fax: (734) 479-1637
NPI assigned: Oct 13, 2007
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

The Slychology Department LLC Adult Mental Health Clinic/Center · Farmington Hills, MI · NPI 1609542646

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
6301013412	MI	MD	Psychologist

Practice roles

Organization	Specialty	Status	New patients
The Slychology Department LLC		Current since Aug 28, 2021	Accepting new patients

Locations

32770 Grand River Ave
Ste 206B
Farmington Hills, MI 48336
Phone (248) 788-5798

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychologist	103T00000X	6301013412	MI	Yes

Addresses

Primary practice location

19366 Allen Rd
Suite C
Brownstown TWP, MI 48183-6809

Mailing address

9237 Becker Ave
Allen Park, MI 48101-1563
Phone (248) 763-9194

Other providers in Brownstown TWP, MI

Khandyce Alaysha Bates
Alissa Becker, CRNP
Kevin J Berlin, DO
Antoinette Berry
Nabil Bhatti, PHARMD
Edward A Blanzy, DO
Bormans Inc
Tanya Michele Brooks, M.A. LPC
Brownstown Pharmacy, Inc.
Tania Isabel Caballero Jimenez, BCSN,MSN, ACNP- BC

All providers in Brownstown TWP, MI · Psychologist in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.