Provider Demographics
NPI:1821018078
Name:MILLER, RYAN L (MA, LLPC, ATC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MA, LLPC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29229 EIFFEL AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3606
Mailing Address - Country:US
Mailing Address - Phone:586-943-3421
Mailing Address - Fax:
Practice Address - Street 1:29229 EIFFEL AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3606
Practice Address - Country:US
Practice Address - Phone:586-943-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0497025382255A2300X
MI6401008871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer