Provider Demographics
NPI:1194394247
Name:RYAN, MICHAEL JOHN (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:RYAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PILOT PT
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4275
Mailing Address - Country:US
Mailing Address - Phone:210-273-7102
Mailing Address - Fax:
Practice Address - Street 1:5804 BABCOCK RD STE 231
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2134
Practice Address - Country:US
Practice Address - Phone:210-685-2266
Practice Address - Fax:210-468-5573
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-15-03101106S00000X
TX5953103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician