Provider Demographics
NPI:1679638191
Name:HINCKLEY, RULON MARK (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:RULON
Middle Name:MARK
Last Name:HINCKLEY
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 1:11175 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8208
Mailing Address - Country:US
Mailing Address - Phone:801-484-9911
Mailing Address - Fax:801-302-7954
Practice Address - Street 1:11175 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8208
Practice Address - Country:US
Practice Address - Phone:801-484-9911
Practice Address - Fax:801-302-7954
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11681635011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical