Provider Demographics
NPI:1952377012
Name:RYAN, THOMAS S (LCPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23819 W MILL ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-3488
Mailing Address - Country:US
Mailing Address - Phone:630-290-3013
Mailing Address - Fax:
Practice Address - Street 1:23819 W MILL ST STE 109
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-3488
Practice Address - Country:US
Practice Address - Phone:630-290-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626747OtherBCBS ID