MEDICARE: RYAN CHERIE THOMAS LCDCIII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	14691	TX
2	106S00000X	Behavior Technician		OH
3	171M00000X	Case Manager/Care Coordinator
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	162656	OH

General Provider Information

NPI Number	:	1467091421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN CHERIE THOMAS LCDCIII

Provider Business Mailing Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-668-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-668-8140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2019
Last Update Date	:	04/08/2025

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