Healthcare Provider Details

I. General information

NPI: 1033883814
Provider Name (Legal Business Name): ETHAN RYAN JONES PHD LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PROFESSIONAL WAY
PAYSON UT
84651-1675
US

IV. Provider business mailing address

39 PROFESSIONAL WAY
PAYSON UT
84651-1675
US

V. Phone/Fax

Practice location:
  • Phone: 801-980-2566
  • Fax:
Mailing address:
  • Phone: 801-980-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12807094-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: