Active NPI
Kevin E Ryan, M.ED LPC
- Counselor
- Willow Grove, PA
National Provider Identifier
1821665522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- PC013135
- Practice address
- 2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735 - Phone
- (484) 440-9740
- NPI assigned
- Jun 10, 2021
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | PC013135 | PA | Primary |
Addresses
Primary practice location
2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735
Mailing address
2300 Computer Rd Ste C15
Willow Grove, PA 19090-1735
Phone (484) 440-9740
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 |
|---|---|---|---|
| PC013135 | PA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dragonfly Psychological Associates | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623283200000",
"number": "1821665522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 COMPUTER RD STE C15",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901735",
"telephone_number": "484-440-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 COMPUTER RD STE C15",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190901735",
"telephone_number": "484-440-9740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "KEVIN",
"middle_name": "E",
"credential": "M.ED LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-10",
"last_updated": "2021-06-10",
"certification_date": "2021-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor",
"state": "PA",
"license": "PC013135",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Grove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.