Provider Demographics
NPI:1376332072
Name:BLACK, RYAN EDWARDS (BCBA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:EDWARDS
Last Name:BLACK
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 1:202 S WEATHERRED DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6021
Mailing Address - Country:US
Mailing Address - Phone:214-803-1215
Mailing Address - Fax:
Practice Address - Street 1:17194 PRESTON RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1203
Practice Address - Country:US
Practice Address - Phone:945-218-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst