Individual
DORIS ODELL RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP
Contact information
Practice address
6655 US 36 EAST, CUMMINS BEHAVIORAL HEALTH SERVICES, AVON, IN 46123
(317) 272-3330
(317) 272-0807
Mailing address
5101 E US HIGHWAY 36, STE 100, AVON, IN 46123-6646
(317) 347-0625
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041969A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342263
ANTHEM BCBS PROVIDER PIN
IN
05
—
200305580
—
IN
Enumeration date
05/19/2006
Last updated
09/19/2017
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