Healthcare Provider Details

I. General information

NPI: 1457192643
Provider Name (Legal Business Name): PSYCH MATTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 UNIVERSITY PARK BLVD STE 200
CLEARFIELD UT
84015-6285
US

IV. Provider business mailing address

PO BOX 65
LAYTON UT
84041-0915
US

V. Phone/Fax

Practice location:
  • Phone: 801-918-6038
  • Fax: 877-559-3988
Mailing address:
  • Phone: 801-918-6038
  • Fax: 877-559-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BRAUN CONRAD TUELLER
Title or Position: FOUNDER/OWNER
Credential: DMS, CAQ-PSY, PA-C
Phone: 801-918-6038