Individual
RYAN JEROME TINGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PROVISIONAL LMHC
Contact information
Practice address
7519 GOSHAWK AVE NW, ALBUQUERQUE, NM 87114-3573
(505) 803-5658
Mailing address
41521 W 11 MILE RD, NOVI, MI 48375-1803
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2022-0676
NM
106S00000X
Behavior Technician
—
—
Other
Enumeration date
04/23/2018
Last updated
09/07/2022
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