Active NPI
Ryan Clarke Vanwinkle, LPC
- Professional Counselor
- Van Buren, MO
National Provider Identifier
1285758698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2002017414
- Practice address
- 402 Elsie St.
Van Buren, MO 63965 - Phone
- (573) 323-0411
- Fax
- (573) 323-0412
- NPI assigned
- Mar 19, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2002017414 | MO | Primary |
Addresses
Primary practice location
402 Elsie St.
Van Buren, MO 63965
Mailing address
PO Box 894
402 Elsie Street
Van Buren, MO 63965-0894
Phone (573) 323-4139
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 495869224 | Medicaid | MO |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002017414 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1285758698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 894",
"address_2": "402 ELSIE STREET",
"city": "VAN BUREN",
"state": "MO",
"postal_code": "639650894",
"telephone_number": "573-323-4139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 ELSIE ST.",
"city": "VAN BUREN",
"state": "MO",
"postal_code": "63965",
"telephone_number": "573-323-0411",
"fax_number": "573-323-0412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWINKLE",
"first_name": "RYAN",
"middle_name": "CLARKE",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2002017414",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "495869224",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Van Buren, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.