MEDICARE: DR. RONALD PATTERSON HOUSTON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	963177482501	UT

General Provider Information

NPI Number	:	1417111485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD PATTERSON HOUSTON PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 148
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-0148
Country	:	US
Telephone Number	:	435-750-7063
Fax Number	:	435-750-7063

Provider Business Practice Location Address
First Line	:	169 SPRING CREEK PKWY
Second Line	:	SUITE 235
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9707
Country	:	US
Telephone Number	:	435-750-7063
Fax Number	:	435-750-7063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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