Healthcare Provider Details

I. General information

NPI: 1144884461
Provider Name (Legal Business Name): RYAN JOHN ANDREWS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E MAIN ST
BOZEMAN MT
59715-3850
US

IV. Provider business mailing address

1315 E MAIN ST
BOZEMAN MT
59715-3850
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-2477
  • Fax:
Mailing address:
  • Phone: 406-587-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPSY-BA-LIC-3178
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: