Provider Demographics
NPI:1174198600
Name:RYAN, BRANDON LAYNE (BCBA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LAYNE
Last Name:RYAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S UNIVERSITY BLVD STE 2H
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7860
Mailing Address - Country:US
Mailing Address - Phone:251-340-2020
Mailing Address - Fax:251-973-8201
Practice Address - Street 1:820 S UNIVERSITY BLVD STE 2H
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7860
Practice Address - Country:US
Practice Address - Phone:251-340-2020
Practice Address - Fax:251-973-8201
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0-24-15484106E00000X
106S00000X
AL1-25-79213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician