Provider Demographics
NPI:1891191730
Name:COLEY, RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 E CHERRY PLUM CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5320
Mailing Address - Country:US
Mailing Address - Phone:801-618-6183
Mailing Address - Fax:
Practice Address - Street 1:558 E CHERRY PLUM CT
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5320
Practice Address - Country:US
Practice Address - Phone:801-618-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7925519-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical