Provider Demographics
NPI:1669047270
Name:ZABRISKIE, RYAN ADAM (LCMHC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ADAM
Last Name:ZABRISKIE
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6557
Mailing Address - Country:US
Mailing Address - Phone:801-427-7862
Mailing Address - Fax:
Practice Address - Street 1:357 S 200 E STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2817
Practice Address - Country:US
Practice Address - Phone:801-341-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10562737-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health