Provider Demographics
NPI:1912512351
Name:VANATTA, RYAN (CMHC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:VANATTA
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 N LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-2148
Mailing Address - Country:US
Mailing Address - Phone:385-259-2269
Mailing Address - Fax:
Practice Address - Street 1:415 MEDICAL DR STE B101
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4989
Practice Address - Country:US
Practice Address - Phone:385-259-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10835115-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health