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General NPI Number Information
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NPI Number | 1376332072
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Entity Type | Individual
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Provider Name | RYAN EDWARDS BLACK BCBA
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Gender | Male
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 17194 PRESTON RD STE 101
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City | DALLAS
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State | TX
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Zip | 75248-1203
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Country | US
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Telephone | 945-218-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 202 S WEATHERRED DR
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City | RICHARDSON
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State | TX
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Zip | 75080-6021
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Country | US
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Telephone | 214-803-1215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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