Healthcare Provider Details

I. General information

NPI: 1174198600
Provider Name (Legal Business Name): BRANDON LAYNE RYAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

IV. Provider business mailing address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-2020
  • Fax: 251-973-8201
Mailing address:
  • Phone: 251-340-2020
  • Fax: 251-973-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15484
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79213
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: