Provider Demographics
NPI:1134584865
Name:SELBERG, RYAN A (BCBA, LBA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:A
Last Name:SELBERG
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 STATE ROUTE 9 SE APT A
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6313
Mailing Address - Country:US
Mailing Address - Phone:360-710-9204
Mailing Address - Fax:
Practice Address - Street 1:6 N EUSTIS ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3408
Practice Address - Country:US
Practice Address - Phone:321-436-9792
Practice Address - Fax:888-719-7820
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-15-01871106S00000X
WABA61057756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician