Active NPI
Glen W Ryswyk, MDIV LPC LMFT
- Mental Health Counselor
- Lawton, OK
National Provider Identifier
1598778920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 577
- Practice address
- 5002 SW Lee Blvd
Lawton, OK 73505-8320 - Phone
- (580) 531-4512
- Fax
- (580) 531-4519
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 577 | OK | Primary |
| Marriage & Family Therapist | 106H00000X | 717 | OK |
Addresses
Primary practice location
5002 SW Lee Blvd
Lawton, OK 73505-8320
Mailing address
5002 SW Lee Blvd
Lawton, OK 73505-8320
Phone (580) 531-4512
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 9, 2025 through Apr 9, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 577 | OK | MD | Addiction (Substance Use Disorder) Counselor |
| 717 | OK | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315958400000",
"number": "1598778920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5002 SW LEE BLVD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735058320",
"telephone_number": "580-531-4512",
"fax_number": "580-531-4519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5002 SW LEE BLVD",
"city": "LAWTON",
"state": "OK",
"postal_code": "735058320",
"telephone_number": "580-531-4512",
"fax_number": "580-531-4519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYSWYK",
"first_name": "GLEN",
"middle_name": "W",
"credential": "MDIV LPC LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2011-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "577",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "OK",
"license": "717",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.