Provider Demographics
NPI:1659027076
Name:MCDERMOTT, RYON C (PHD)
Entity Type:Individual
Prefix:MISS
First Name:RYON
Middle Name:C
Last Name:MCDERMOTT
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:PO BOX 41241
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-1241
Mailing Address - Country:US
Mailing Address - Phone:866-648-7334
Mailing Address - Fax:251-405-3323
Practice Address - Street 1:1156 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2726
Practice Address - Country:US
Practice Address - Phone:866-648-7334
Practice Address - Fax:251-405-3323
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1994103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL257843Medicaid