Provider Demographics
NPI:1972067577
Name:SCOGGAN, RICKY RYAN (LMFT)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:RYAN
Last Name:SCOGGAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 S HIGHLAND DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2646
Mailing Address - Country:US
Mailing Address - Phone:801-809-2601
Mailing Address - Fax:
Practice Address - Street 1:4141 S HIGHLAND DR STE 202
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-2646
Practice Address - Country:US
Practice Address - Phone:801-809-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5322474-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty