Provider Demographics
NPI:1801360458
Name:HENSON, RYAN JAMAL
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAMAL
Last Name:HENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8269 BRILLIANT POMPON PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3775
Mailing Address - Country:US
Mailing Address - Phone:702-468-6481
Mailing Address - Fax:
Practice Address - Street 1:8269 BRILLIANT POMPON PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-3775
Practice Address - Country:US
Practice Address - Phone:702-468-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst