Provider Demographics
NPI:1669704102
Name:CHRISTENSEN, RYAN JAMES (LPC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 EAST 1400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097
Mailing Address - Country:US
Mailing Address - Phone:801-426-6661
Mailing Address - Fax:801-426-6660
Practice Address - Street 1:570 EAST 1400 SOUTH
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097
Practice Address - Country:US
Practice Address - Phone:801-426-6661
Practice Address - Fax:801-426-6660
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353763-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health