Provider Demographics
NPI:1912148503
Name:RYDER, REBECCA L (MA,LPCC-S,NCC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:RYDER
Suffix:
Gender:F
Credentials:MA,LPCC-S,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 E SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8773
Mailing Address - Country:US
Mailing Address - Phone:330-241-9745
Mailing Address - Fax:
Practice Address - Street 1:4025 E SMITH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8773
Practice Address - Country:US
Practice Address - Phone:330-241-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0700866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098331Medicaid