Provider Demographics
NPI:1508126285
Name:THOMPSON, RYAN P (CMHC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR STE F202
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7351
Mailing Address - Country:US
Mailing Address - Phone:435-216-8688
Mailing Address - Fax:435-214-2482
Practice Address - Street 1:321 N MALL DR STE F202
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7351
Practice Address - Country:US
Practice Address - Phone:435-216-8688
Practice Address - Fax:435-214-2482
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77863566009101YM0800X
UT77863566004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1015113Medicaid