Provider Demographics
NPI:1326405192
Name:CECYS, ERIC (LSW, LICDC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:CECYS
Suffix:
Gender:M
Credentials:LSW, LICDC
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:MARTIN
Other - Last Name:CECYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, LICDC
Mailing Address - Street 1:228 N BARRON ST
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-1704
Mailing Address - Country:US
Mailing Address - Phone:937-456-7694
Mailing Address - Fax:937-456-7753
Practice Address - Street 1:228 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1704
Practice Address - Country:US
Practice Address - Phone:937-456-7694
Practice Address - Fax:937-456-7753
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005468104100000X
OHI.23049591041C0700X
OHIICDC.162018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)