Provider Demographics
NPI:1407878671
Name:RYAN, PARNELL E (PHD)
Entity Type:Individual
Prefix:
First Name:PARNELL
Middle Name:E
Last Name:RYAN
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 1:3609 SMITH BARRY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4631
Mailing Address - Country:US
Mailing Address - Phone:682-551-4729
Mailing Address - Fax:855-205-0626
Practice Address - Street 1:3609 SMITH BARRY RD STE 150
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4631
Practice Address - Country:US
Practice Address - Phone:682-551-4729
Practice Address - Fax:855-205-0626
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0267874-02Medicaid