Provider Demographics
NPI:1669766317
Name:RISHTON, KIP T (CSW)
Entity type:Individual
Prefix:MR
First Name:KIP
Middle Name:T
Last Name:RISHTON
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 GOLDEN PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8462
Mailing Address - Country:US
Mailing Address - Phone:801-577-4065
Mailing Address - Fax:
Practice Address - Street 1:5250 COMMERCE DR
Practice Address - Street 2:STE 190
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7926
Practice Address - Country:US
Practice Address - Phone:801-577-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5462356-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical