Active NPI
Jerry David Ryan, LPC.CRC.NCC,MS
- Professional Counselor
- Oregon City, OR
National Provider Identifier
1245667385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 19142 Molalla Ave., Suite a,
Oregon City, OR 97045-7166 - Phone
- (503) 348-6177
- Fax
- (593) 632-5497
- NPI assigned
- Oct 3, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | R2757 | OR | |
| Professional Counselor | 101YP2500X | OR | Primary |
Addresses
Primary practice location
19142 Molalla Ave., Suite a,
Oregon City, OR 97045-7166
Mailing address
PO Box 548
19142 Molalla Ave, Suite a
Oregon City, OR 97045-7166
Phone (503) 348-6177
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5006884107 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R2757 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478736000000",
"number": "1245667385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 548",
"address_2": "19142 MOLALLA AVE, SUITE A",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970457166",
"telephone_number": "503-348-6177",
"fax_number": "503-632-5497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19142 MOLALLA AVE., SUITE A,",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970457166",
"telephone_number": "503-348-6177",
"fax_number": "593-632-5497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "JERRY",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "LPC.CRC.NCC,MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-03",
"last_updated": "2016-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "R2757",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5006884107",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.