Provider Demographics
NPI:1831117886
Name:GANT, RALPH WESLEY (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WESLEY
Last Name:GANT
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 EAST SOUTH TEMPLE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1490
Mailing Address - Country:US
Mailing Address - Phone:801-521-0182
Mailing Address - Fax:801-521-0196
Practice Address - Street 1:807 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1339
Practice Address - Country:US
Practice Address - Phone:801-521-0182
Practice Address - Fax:801-521-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1093732501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist