Provider Demographics
NPI:1104428259
Name:BOYETTE, RYAN NICOLE (BCABA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NICOLE
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16782 VON KARMAN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-550-6368
Practice Address - Street 1:725 S MESA HILLS DR STE 201
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5568
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:619-550-6368
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3741103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst