Provider Demographics
NPI:1891338810
Name:PARKER, RYAN JACOB (BCBA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JACOB
Last Name:PARKER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHAPANOKE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3400
Mailing Address - Country:US
Mailing Address - Phone:919-773-2020
Mailing Address - Fax:919-773-1044
Practice Address - Street 1:314 CHAPANOKE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3400
Practice Address - Country:US
Practice Address - Phone:919-773-2020
Practice Address - Fax:919-773-1044
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC1-22-59750103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty