Provider Demographics
NPI:1386058782
Name:RALEIGH, RYAN (ACMHC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:RALEIGH
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E 5600 S STE 302
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8149
Mailing Address - Country:US
Mailing Address - Phone:801-419-8002
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S STE 302
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8149
Practice Address - Country:US
Practice Address - Phone:801-419-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8599630-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health