Provider Demographics
NPI:1417111485
Name:HOUSTON, RONALD PATTERSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PATTERSON
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-0148
Mailing Address - Country:US
Mailing Address - Phone:435-750-7063
Mailing Address - Fax:435-750-7063
Practice Address - Street 1:169 SPRING CREEK PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9707
Practice Address - Country:US
Practice Address - Phone:435-750-7063
Practice Address - Fax:435-750-7063
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT963177482501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007594Medicare PIN