Provider Demographics
NPI:1164469508
Name:JEFFS, RYAN LARRY (MS LMFT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LARRY
Last Name:JEFFS
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13628 SOUTH PREMIER LANE
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1702
Mailing Address - Country:US
Mailing Address - Phone:801-446-1624
Mailing Address - Fax:
Practice Address - Street 1:592 WEST 1350 SOUTH
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087
Practice Address - Country:US
Practice Address - Phone:801-299-5360
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56962563902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist