Provider Demographics
NPI:1548403694
Name:ANDERSON, RYAN JOHN (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 E 1200 S # 201
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6904
Mailing Address - Country:US
Mailing Address - Phone:801-310-4028
Mailing Address - Fax:
Practice Address - Street 1:363 E 1200 S # 201
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6904
Practice Address - Country:US
Practice Address - Phone:801-310-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6883941-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist