Active NPI
Ryan Laine
- Mental Health Counselor
- Palmer, AK
National Provider Identifier
1588057400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 208457
- Practice address
- 11350 E Palmer Wasilla Hwy
Palmer, AK 99645-7425 - Phone
- (530) 680-3010
- NPI assigned
- Mar 17, 2015
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 208457 | AK | Primary |
Addresses
Primary practice location
11350 E Palmer Wasilla Hwy
Palmer, AK 99645-7425
Mailing address
780 N Luke St
Wasilla, AK 99654-6651
Phone (530) 680-3010
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 |
|---|---|---|---|
| 208457 | AK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1588057400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "780 N LUKE ST",
"city": "WASILLA",
"state": "AK",
"postal_code": "996546651",
"telephone_number": "530-680-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11350 E PALMER WASILLA HWY",
"city": "PALMER",
"state": "AK",
"postal_code": "996457425",
"telephone_number": "530-680-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAINE",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-17",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AK",
"license": "208457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.