Individual
DR. RYAN LEE BLACKSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D., LP
Contact information
Practice address
19366 ALLEN RD, SUITE C, BROWNSTOWN TWP, MI 48183-6809
(734) 479-0949
(734) 479-1637
Mailing address
9237 BECKER AVE, ALLEN PARK, MI 48101-1563
(248) 763-9194
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013412
MI
Other
Enumeration date
10/13/2007
Last updated
08/27/2010
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