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
State | License ID | Taxonomies |
---|---|---|
101YA0400X, 101YP1600X, 103K00000X, 133NN1002X, 171M00000X, 172V00000X, 174400000X, 174H00000X, 175F00000X, 246Z00000X | ||
PA | 225CA2400X, 225CA2500X | |
MD | 225CA2400X | |
WV | 225CA2400X | |
OH | 225CA2400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 246Z00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 172V00000X | Other Service Providers | Community Health Worker | |
No | 174400000X | Other Service Providers | Specialist | |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 175F00000X | Other Service Providers | Naturopath | |
No | 225CA2400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Practitioner |
No | 225CA2500X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | PA-2279(B) | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
VA | PA-2279(B) | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
70393001 | Other | BOARD CERTIFICATION AADP (AMERICAN ASSOCIATION OF DRUGLESS PRACTITIONERS) | |
PA | DC0234 | Other | BOARD CERTIFICATION- DISASTER CRISIS OUTREACH&REFERRAL PROF. (PA CERT. BOARD) |
AL011937 | Other | UNION CERTIFICATION BY HYPNOTHERAPISTS LOCAL NO. 472 | |
OH | PA-2279(B) | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
MD | PA-2279(B) | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
WV | PA-2279(B) | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
NP-001070 | Other | BOARD CERTIFICATION AIP (ASSOCIATION FOR INTEGRATIVE PSYCHOLOGY) |