Basic Information
| Provider Information | |||||||||
| NPI: | 1811137318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | FRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 EAST 3300 SOUTH | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014831600 | ||||||||
| FaxNumber: | 8014831610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 E 3300 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841062522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014831600 | ||||||||
| FaxNumber: | 8014831610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2009 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 378080-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TF0200X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103TM1800X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TS0200X | 378080-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.