Individual
RYAN C DIX
Active
Individual
RYAN C DIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
16500000
OR
103TC0700X
Clinical Psychologist
Primary
2102
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12152292
CAQH ID
OR
05
—
500626193
—
OR
Enumeration date
09/15/2010
Last updated
10/14/2020
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