Healthcare Provider Details

I. General information

NPI: 1811137318
Provider Name (Legal Business Name): RYAN FRED HOUSTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E 3300 S
SALT LAKE CITY UT
84106-2522
US

IV. Provider business mailing address

1208 EAST 3300 SOUTH
SALT LAKE CITY UT
84106
US

V. Phone/Fax

Practice location:
  • Phone: 801-483-1600
  • Fax: 801-483-1610
Mailing address:
  • Phone: 801-483-1600
  • Fax: 801-483-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number378080-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number378080-2501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number378080-2501
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number378080-2501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number378080-2501
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number378080-2501
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number378080-2501
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number378080-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: