Provider Demographics
NPI:1982880787
Name:RICHTER, RYAN CAMERON (MS, LPC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CAMERON
Last Name:RICHTER
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 LINCOLN AVE
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6515
Mailing Address - Country:US
Mailing Address - Phone:801-784-8720
Mailing Address - Fax:
Practice Address - Street 1:2036 LINCOLN AVE
Practice Address - Street 2:SUITE 102B
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6515
Practice Address - Country:US
Practice Address - Phone:801-784-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5960489-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health