Provider Demographics
NPI:1235594466
Name:DOUGLAS, RYAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6864
Mailing Address - Country:US
Mailing Address - Phone:512-879-1836
Mailing Address - Fax:
Practice Address - Street 1:8701 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6864
Practice Address - Country:US
Practice Address - Phone:512-879-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37206103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling