Provider Demographics
NPI:1366119174
Name:BRANDT, RYAN KELSEY (LPC, ATR-P)
Entity type:Individual
Prefix:MS
First Name:RYAN
Middle Name:KELSEY
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 W BELDEN AVE UNIT 1104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2464
Mailing Address - Country:US
Mailing Address - Phone:281-541-6689
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR STE 320
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1471
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:847-759-9440
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017836101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.017836OtherIDFPR
23-013OtherART THERAPY CREDENTIALS BOARD INC.