Provider Demographics
NPI:1053193649
Name:PRATT, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 WIMBLEDON DR SW APT 6
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2849
Mailing Address - Country:US
Mailing Address - Phone:810-358-3222
Mailing Address - Fax:
Practice Address - Street 1:2450 VAN OMMEN DR STE C
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8085
Practice Address - Country:US
Practice Address - Phone:616-350-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)