Provider Demographics
NPI:1134734536
Name:SELLERS, RYON (MED, LBA, BCBA)
Entity type:Individual
Prefix:
First Name:RYON
Middle Name:
Last Name:SELLERS
Suffix:
Gender:M
Credentials:MED, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 N DREAMY DRAW DR UNIT 156
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4654
Mailing Address - Country:US
Mailing Address - Phone:253-426-9627
Mailing Address - Fax:
Practice Address - Street 1:4602 E UNIVERSITY DR STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7430
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-20-43303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst