Provider Demographics
NPI:1922244607
Name:BECK, RYAN RAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RAY
Last Name:BECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2713
Mailing Address - Country:US
Mailing Address - Phone:678-846-6387
Mailing Address - Fax:
Practice Address - Street 1:243 E. GIRARD AVENUE
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125
Practice Address - Country:US
Practice Address - Phone:678-846-6387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA439349458AMedicaid