Provider Demographics
NPI:1174132765
Name:WELKER MCGRATH, RYEN LEE
Entity type:Individual
Prefix:MR
First Name:RYEN
Middle Name:LEE
Last Name:WELKER MCGRATH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RYEN
Other - Middle Name:LEE
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8516 NE KNOTT ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5386
Mailing Address - Country:US
Mailing Address - Phone:503-887-8401
Mailing Address - Fax:
Practice Address - Street 1:8516 NE KNOTT ST UNIT A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5386
Practice Address - Country:US
Practice Address - Phone:503-887-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health