Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 1-0-1376 | GA |
NPI | 1174034011 |
---|---|
Provider Name | Ryan Simmons Berry |
First Address | Roswell, GA 30076-3878 |
Second Address | Roswell, GA 30076-3878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2017 |
Last Update Date | 18/10/2017 |