Provider Demographics
NPI:1881949360
Name:BELLER, RYAN ALLYCE
Entity type:Individual
Prefix:MISS
First Name:RYAN
Middle Name:ALLYCE
Last Name:BELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24047 STATE HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-6966
Mailing Address - Country:US
Mailing Address - Phone:405-570-4282
Mailing Address - Fax:
Practice Address - Street 1:24047 STATE HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-6966
Practice Address - Country:US
Practice Address - Phone:405-570-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation