Healthcare Provider Details

I. General information

NPI: 1699177659
Provider Name (Legal Business Name): RYAN BORCHERS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 CHAGRIN BLVD #400
BEACHWOOD OH
44122-5535
US

IV. Provider business mailing address

25700 SCIENCE PARK DRIVE, SUITE 200 LANDMARK CENTRE.
BEACHWOOD OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-1040
  • Fax: 216-831-2667
Mailing address:
  • Phone: 216-831-1040
  • Fax: 216-831-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0701148
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0701148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: