Individual
RYAN DAVID BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
249 OLIVER EDWARDS RD, JONESBOROUGH, TN 37659-6537
(423) 341-7104
(423) 753-6952
Mailing address
632 SUNRISE TRL, SEYMOUR, TN 37865-3308
(865) 985-1830
(423) 753-6952
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192
LICENSED BEHAVIOR ANALYST
TN
05
—
Q021186
—
TN
Enumeration date
01/15/2009
Last updated
03/17/2018
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