Provider Demographics
NPI:1073052056
Name:RYAN, ANDREA (LPCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 EDGEVALE RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2638
Mailing Address - Country:US
Mailing Address - Phone:419-490-4601
Mailing Address - Fax:
Practice Address - Street 1:217 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1414
Practice Address - Country:US
Practice Address - Phone:419-490-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1600839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health