Healthcare Provider Details

I. General information

NPI: 1639702293
Provider Name (Legal Business Name): RYAN RAYNES BCABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OAKWOOD RD STE 300
CHARLESTON WV
25314-2071
US

IV. Provider business mailing address

888 OAKWOOD RD
CHARLESTON WV
25314-2000
US

V. Phone/Fax

Practice location:
  • Phone: 681-265-0999
  • Fax:
Mailing address:
  • Phone: 681-265-0999
  • Fax: 681-217-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91004
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: