Individual
DR. RYAN JOSEPH STIVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., LMFT, LPC
Contact information
Practice address
1717 W CANDLETREE DR, STE. B, PEORIA, IL 61614-1592
(309) 713-1485
Mailing address
PO BOX 10286, PEORIA, IL 61612-0286
(309) 713-1485
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
P1111086
AR
106H00000X
Marriage & Family Therapist
Primary
166001032
IL
106H00000X
Marriage & Family Therapist
M1206007
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182287795
—
AR
Enumeration date
06/15/2010
Last updated
11/01/2016
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