Individual
RYAN WILLIAM MAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
TLLP
Contact information
Practice address
17320 W 12 MILE RD STE 101, SOUTHFIELD, MI 48076-2102
(248) 727-3456
(248) 557-4697
Mailing address
17320 W 12 MILE RD, SOUTHFIELD, MI 48076-2100
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362009759
MI
Other
Enumeration date
09/14/2022
Last updated
08/09/2023
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