Ryan Tierra Davenport, LPCA
Individual provider Active NPI Professional Counselor · Lexington, KY
NPI 1376088021 · NPPES record last updated Oct 23, 2023
Key facts
- NPI
- 1376088021
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 287775 (KY)
- Practice address
- 1255 Providence Place Pkwy Ste 115
Lexington, KY 40511-8379 - Phone
- (216) 468-5000
- Fax
- (216) 456-8128
- NPI assigned
- Jan 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Psychological and Behavioral Consultants LLC
Practice addresses (Care Compare)
1255 Providence LN
Suite 115
Lexington, KY 40502-2380
Phone (216) 468-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240708003229 | KY | Practitioner - Mental Health Counselor | 2961947585 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246478 | KY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological & Behavioral Consultants, LLC | Mental Health | Current |
Accepting new patients |
| Commonwealth Behavioral Health & Counseling | Professional | Past |
Accepting new patients |
Locations
1255 Providence Place Pkwy
Ste 115
Lexington, KY 40511
Phone (859) 214-7440
100 Executive Park
Ste 103
Louisville, KY 40207
Phone (502) 313-6880
25101 Chagrin Blvd
Ste 100
Beachwood, OH 44122
Phone (216) 245-4468
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 246478 | KY | |
| Professional Counselor | 101YP2500X | 287775 | KY | Yes |
Addresses
Primary practice location
1255 Providence Place Pkwy Ste 115
Lexington, KY 40511-8379
Mailing address
1255 Providence Place Pkwy Ste 115
Lexington, KY 40511-8379
Phone (216) 468-5000
Other practice location 1
5 Linville Dr
Paris, KY 40361-2165
Phone (138) 347-0635
Other providers in Lexington, KY
- Phillip Daugherty
- William Daugherty
- Davanand Doodnauth,M.D., PSC
- Kinjal Dave
- Robert Alan Davenport
- William Patrick Davey
- David B Cassidy, MD, PLLC
- David Feinberg
- David L. Jackson, M.D., PSC
- David L. Wells II DMD MD PLLC
All providers in Lexington, KY · Professional Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.