Provider Demographics
NPI:1275087454
Name:CEYLER, MICHELLE (LPCC-S, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CEYLER
Suffix:
Gender:F
Credentials:LPCC-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3976
Mailing Address - Country:US
Mailing Address - Phone:937-980-3252
Mailing Address - Fax:
Practice Address - Street 1:405 PUBLIC SQ STE 350
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-5200
Practice Address - Country:US
Practice Address - Phone:937-980-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161552101YA0400X
OHE.1800774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2901051Medicaid