| Doctor Name: | MR. RYAN CLARKE VANWINKLE |
| NPI Number: | 1285758698 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 2002017414 |
| Business Practice Address: | 402 Elsie St. Van Buren, MO - 63965 |
| Business Phone Number: | 5733230411 |
| Business Fax Number: | 5733230412 |
| Mailing Address: | Po Box 894, 402 Elsie Street VAN BUREN |
| State: | MO |
| Postal Code: | 639650894 |
| Phone Number: | 5733234139 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2007 |
| NPI Last Update Date: | 02/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2002017414 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |