Provider Demographics
NPI:1639870983
Name:ESTEP, RYAN L (CDCA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:ESTEP
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-7744
Mailing Address - Country:US
Mailing Address - Phone:937-284-1823
Mailing Address - Fax:
Practice Address - Street 1:2317 E HOME RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2520
Practice Address - Country:US
Practice Address - Phone:937-390-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty