Individual
GLEN W RYSWYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDIV LPC LMFT
Contact information
Practice address
5002 SW LEE BLVD, LAWTON, OK 73505-8320
(580) 531-4512
(580) 531-4519
Mailing address
5002 SW LEE BLVD, LAWTON, OK 73505-8320
(580) 531-4512
(580) 531-4519
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
577
OK
106H00000X
Marriage & Family Therapist
717
OK
Other
Enumeration date
08/15/2006
Last updated
09/14/2011
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