Provider Demographics
NPI:1528497195
Name:CHRISTIANSEN, RYAN (LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR STE VW103
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7337
Mailing Address - Country:US
Mailing Address - Phone:435-359-2687
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE VW103
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7337
Practice Address - Country:US
Practice Address - Phone:435-359-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5708158-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical