Provider Demographics
NPI:1356902282
Name:LYBBERT, RAGAN ANDREW (MS)
Entity type:Individual
Prefix:
First Name:RAGAN
Middle Name:ANDREW
Last Name:LYBBERT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CENTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3154
Mailing Address - Country:US
Mailing Address - Phone:801-332-9660
Mailing Address - Fax:
Practice Address - Street 1:1 E CENTER ST STE 300
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3154
Practice Address - Country:US
Practice Address - Phone:801-332-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist