Provider Demographics
NPI:1255527503
Name:RYAN, TOBIAS A (PSYD)
Entity type:Individual
Prefix:DR
First Name:TOBIAS
Middle Name:A
Last Name:RYAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:360-657-9742
Mailing Address - Fax:
Practice Address - Street 1:400 E EVERGREEN BLVD STE 221
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:360-657-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1905103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1255527503OtherEIN: 30-0565973
WAPY60209157OtherWASHINGTON STATE
OR1905OtherOREGON BOARD OF PSYCHOLOGIST EXAMINERS