Organization
RYAN MACKS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN MACKS PH.D. (LICENSED CLINICAL PSYCHOLOGIST)
(513) 204-5746
Entity
Organization
Contact information
Practice address
7577 CENTRAL PARKE BLVD, SUITE 113, MASON, OH 45040-6810
(513) 204-5746
(513) 229-3707
Mailing address
7577 CENTRAL PARKE BLVD, SUITE 113, MASON, OH 45040-6810
(513) 204-5746
(513) 229-3707
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6162
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080731
—
OH
05
—
2592725
—
OH
01
—
MACP79161
MEDICARE
OH
Enumeration date
03/07/2013
Last updated
05/17/2013
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