Provider Demographics
NPI:1194106906
Name:LETTICE, RYAN EMERSON (BCBA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:EMERSON
Last Name:LETTICE
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 1:27403 YNEZ RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4616
Mailing Address - Country:US
Mailing Address - Phone:714-307-6667
Mailing Address - Fax:
Practice Address - Street 1:27403 YNEZ RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4616
Practice Address - Country:US
Practice Address - Phone:714-307-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst