| Doctor Name: | RYAN IBARRA |
| NPI Number: | 1104281237 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LLPC |
| License Number: | 6401011239 |
| Business Practice Address: | 131 W Seaway Dr Norton Shores, MI - 494443756 |
| Business Phone Number: | 2313758063 |
| Business Fax Number: | |
| Mailing Address: | 1306 Dickinson, Se, GRAND RAPIDS |
| State: | MICHIGAN |
| Postal Code: | 49507 |
| Phone Number: | 6164901189 |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2015 |
| NPI Last Update Date: | 12/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401011239 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |