Provider Demographics
NPI:1982266904
Name:RYAN, RACHEAL ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COURTNEY LN
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9378
Mailing Address - Country:US
Mailing Address - Phone:229-376-8305
Mailing Address - Fax:
Practice Address - Street 1:421 COURTNEY LN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9378
Practice Address - Country:US
Practice Address - Phone:229-376-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-23-14329106E00000X
RBT-18-73315106S00000X
1-24-70760103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician