Provider Demographics
NPI:1447798384
Name:MILLER, RYAN ANDREW (MA, LPCC-S, LICDC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ANDREW
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA, LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 FOREST LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8115
Mailing Address - Country:US
Mailing Address - Phone:330-703-0105
Mailing Address - Fax:
Practice Address - Street 1:3575 FOREST LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8115
Practice Address - Country:US
Practice Address - Phone:330-703-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900626-SUPV101YM0800X, 101YP2500X, 101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0228102Medicaid