| Intermountain Psychology Llc | |
|
3544 Lincoln Ave Suite C Ogden UT 84401-4045 | |
| (801) 913-0098 | |
| (801) 272-3857 |
| Full Name | Intermountain Psychology Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3544 Lincoln Ave, Ogden, Utah |
| Authorized Official Name and Position | Randy Lynn Ryan (REGISTERED AGENT) |
| Authorized Official Contact | 8019130098 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Psychology Llc Po Box 17586 Salt Lake City UT 84117-0586 Ph: (801) 913-0098 | Intermountain Psychology Llc 3544 Lincoln Ave Suite C Ogden UT 84401-4045 Ph: (801) 913-0098 |
| NPI Number | 1174852289 |
|---|---|
| Provider Enumeration Date | 12/18/2009 |
| Last Update Date | 03/16/2010 |
| Medicare PECOS PAC ID | 1658414701 |
|---|---|
| Medicare Enrollment ID | O20100211000403 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174852289 | NPI | - | NPPES |
| 000068518 | Other | UT | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Randy L Ryan |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578893129 PECOS PAC ID: 0941343115 Enrollment ID: I20100210000425 |
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