Provider Demographics
NPI:1487402061
Name:GRIFFITH, RYAN O'NEIL (CADCA1)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:O'NEIL
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:CADCA1
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:O'NEIL
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADCA1
Mailing Address - Street 1:508 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1610
Mailing Address - Country:US
Mailing Address - Phone:270-309-0075
Mailing Address - Fax:
Practice Address - Street 1:4747 OLD DUBLIN RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-8404
Practice Address - Country:US
Practice Address - Phone:800-213-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)