Provider Demographics
NPI:1649577222
Name:SMITH, RYAN (BA,CSMS,CNLP,CHHP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BA,CSMS,CNLP,CHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 COCHRAN RD
Mailing Address - Street 2:#140
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1253
Mailing Address - Country:US
Mailing Address - Phone:412-969-2733
Mailing Address - Fax:412-774-2069
Practice Address - Street 1:210 BOWER HILL RD
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1419
Practice Address - Country:US
Practice Address - Phone:412-760-4626
Practice Address - Fax:412-774-2069
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP1600X, 103K00000X, 133NN1002X, 171M00000X, 172V00000X, 174400000X, 174H00000X, 175F00000X, 246Z00000X
PA225CA2400X, 225CA2500X
MD225CA2400X
WV225CA2400X
OH225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA-2279(B)OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
VAPA-2279(B)OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
70393001OtherBOARD CERTIFICATION AADP (AMERICAN ASSOCIATION OF DRUGLESS PRACTITIONERS)
PADC0234OtherBOARD CERTIFICATION- DISASTER CRISIS OUTREACH&REFERRAL PROF. (PA CERT. BOARD)
AL011937OtherUNION CERTIFICATION BY HYPNOTHERAPISTS LOCAL NO. 472
OHPA-2279(B)OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
MDPA-2279(B)OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
WVPA-2279(B)OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
NP-001070OtherBOARD CERTIFICATION AIP (ASSOCIATION FOR INTEGRATIVE PSYCHOLOGY)