Individual
MARK ANTHONY RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPA
Contact information
Practice address
3504 PRIMROSE AVE, FORT WORTH, TX 76111-4945
(817) 726-7504
Mailing address
3504 PRIMROSE AVE, FORT WORTH, TX 76111-4945
(817) 726-7504
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
34184
TX
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
34184
TX
Other
Enumeration date
05/05/2025
Last updated
05/05/2025
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