Provider Demographics
NPI:1891229456
Name:RYALS, RASHEED A
Entity Type:Individual
Prefix:
First Name:RASHEED
Middle Name:A
Last Name:RYALS
Suffix:
Gender:M
Credentials:
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 45474
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-5474
Mailing Address - Country:US
Mailing Address - Phone:325-650-5846
Mailing Address - Fax:
Practice Address - Street 1:6639 W HOLLILYNN DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-7271
Practice Address - Country:US
Practice Address - Phone:208-598-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical