Active NPI
Tobias A Ryan, PSYD
- Clinical Psychologist
- Vancouver, WA
National Provider Identifier
1255527503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1905
- Practice address
- 400 E Evergreen Blvd Ste 221
Vancouver, WA 98660-3264 - Phone
- (360) 657-9742
- NPI assigned
- Sep 20, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1905 | OR | Primary |
Addresses
Primary practice location
400 E Evergreen Blvd Ste 221
Vancouver, WA 98660-3264
Mailing address
400 E Evergreen Blvd Ste 221
Vancouver, WA 98660-3264
Phone (360) 657-9742
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255527503 | Other | OR | EIN: 30-0565973 |
| PY60209157 | Other | WA | WASHINGTON STATE |
| 1905 | Other | OR | OREGON BOARD OF PSYCHOLOGIST EXAMINERS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1905 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738195200000",
"number": "1255527503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E EVERGREEN BLVD STE 221",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603264",
"telephone_number": "360-657-9742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E EVERGREEN BLVD STE 221",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603264",
"telephone_number": "360-657-9742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "TOBIAS",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-20",
"last_updated": "2025-01-30",
"certification_date": "2025-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1905",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EIN: 30-0565973",
"identifier": "1255527503",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE",
"identifier": "PY60209157",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON BOARD OF PSYCHOLOGIST EXAMINERS",
"identifier": "1905",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.