Healthcare Provider Details

I. General information

NPI: 1992188486
Provider Name (Legal Business Name): RYAN PETERSON CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 S MONROE PLAZA WAY STE C
SANDY UT
84070-2692
US

IV. Provider business mailing address

9135 S MONROE PLAZA WAY STE C
SANDY UT
84070-2692
US

V. Phone/Fax

Practice location:
  • Phone: 801-879-1629
  • Fax:
Mailing address:
  • Phone: 801-879-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129164036004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: