Healthcare Provider Details

I. General information

NPI: 1790585263
Provider Name (Legal Business Name): RYAN E GILL LAC, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

IV. Provider business mailing address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

V. Phone/Fax

Practice location:
  • Phone: 463-999-9045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99129585A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number86000438A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: