Provider Demographics
NPI:1932462363
Name:RENNER, RYAN LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:RENNER
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 1:23181 VERDUGO DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1357
Mailing Address - Country:US
Mailing Address - Phone:949-457-9203
Mailing Address - Fax:949-457-9213
Practice Address - Street 1:23181 VERDUGO DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1357
Practice Address - Country:US
Practice Address - Phone:949-457-9203
Practice Address - Fax:949-457-9213
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-6484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst