| Lark Ryan, Lcsw, Llc | |
|
1525 Ne Weidler St # 101 Portland OR 97232-1410 | |
| (503) 994-9141 | |
| (971) 232-3042 |
| Full Name | Lark Ryan, Lcsw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1525 Ne Weidler St # 101, Portland, Oregon |
| Authorized Official Name and Position | Lark Webster Ryan (OWNER) |
| Authorized Official Contact | 5032874975 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lark Ryan, Lcsw, Llc 1525 Ne Weidler St Ste 101 Portland OR 97232-1410 Ph: (503) 994-9141 | Lark Ryan, Lcsw, Llc 1525 Ne Weidler St # 101 Portland OR 97232-1410 Ph: (503) 994-9141 |
| NPI Number | 1538599055 |
|---|---|
| Provider Enumeration Date | 11/19/2013 |
| Last Update Date | 02/21/2024 |
| Certification Date | 02/21/2024 |
| Medicare PECOS PAC ID | 3476784463 |
|---|---|
| Medicare Enrollment ID | O20140314000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538599055 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | L2683 (Oregon) | Primary |
| Provider Name | Lark W Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942366844 PECOS PAC ID: 1153426242 Enrollment ID: I20070418000406 |
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