| Doctor Name: | RYAN T NEACE |
| NPI Number: | 1003171984 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LPC, NCC, CCMHC |
| License Number: | 2013014281 |
| Business Practice Address: | 5859 S Kingshighway Blvd Change, Inc. Saint Louis, MO - 631093571 |
| Business Phone Number: | 3146696242 |
| Business Fax Number: | 8665965017 |
| Mailing Address: | 5859 S Kingshighway Blvd, Change, Inc. SAINT LOUIS |
| State: | MO |
| Postal Code: | 631093571 |
| Phone Number: | 3146696242 |
| Fax Number: | |
| NPI Enumeration Date: | 07/07/2012 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2013014281 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |