Provider Demographics
NPI:1598037095
Name:RYAN CONSULTING COLLABORATIVE
Entity Type:Organization
Organization Name:RYAN CONSULTING COLLABORATIVE
Other - Org Name:SANDBOX ABA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:512-590-0505
Mailing Address - Street 1:PO BOX 303067
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0052
Mailing Address - Country:US
Mailing Address - Phone:512-590-0505
Mailing Address - Fax:512-454-8931
Practice Address - Street 1:4007 MARATHON BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3717
Practice Address - Country:US
Practice Address - Phone:512-524-1374
Practice Address - Fax:512-524-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty