Provider Demographics
NPI:1245554567
Name:SKELTON, RYAN LEE (PSY D)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:SKELTON
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E POWELL BLVD
Mailing Address - Street 2:305
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7624
Mailing Address - Country:US
Mailing Address - Phone:503-789-9394
Mailing Address - Fax:
Practice Address - Street 1:123 E POWELL BLVD
Practice Address - Street 2:305
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7624
Practice Address - Country:US
Practice Address - Phone:503-789-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1911103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral