Healthcare Provider Details

I. General information

NPI: 1669733143
Provider Name (Legal Business Name): GLENN A MATCHETT-MORRIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E LOWELL ST
TUCSON AZ
85721-0095
US

IV. Provider business mailing address

1224 E LOWELL ST P.O. BOX 210095
TUCSON AZ
85721-0095
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-3334
  • Fax: 520-621-6105
Mailing address:
  • Phone: 520-621-3334
  • Fax: 520-621-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3726
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: