Intermountain Psychology LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

INTERMOUNTAIN PSYCHOLOGY LLC

Practice address

3544 Lincoln Ave
Suite C
Ogden, UT 84401-4045

Phone

(801) 913-0098

Fax

(801) 272-3857

NPI assigned

Dec 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Randy Lynn Ryan, PSY.D.NPI 1578893129

Title

Registered Agent

Phone

(801) 913-0098

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randy Lynn Ryan, PSY.D.

  • Clinical Psychologist
  • West Jordan, UT
  • NPI 1578893129
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1174852289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17586",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841170586",
            "telephone_number": "801-913-0098",
            "fax_number": "801-272-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3544 LINCOLN AVE",
            "address_2": "SUITE C",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844014045",
            "telephone_number": "801-913-0098",
            "fax_number": "801-272-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN PSYCHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-18",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "801-913-0098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000068518",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Miranda Berchtold Ipsen, OTR/L
• Suleman Iqbal, M.D.
• Shawn Dale Isaeff, M.D.

• Adult Mental Health Clinic/Center in Ogden, UT
• Providers in Ogden, UT by specialty
• Adult Mental Health Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.