Healthcare Provider Details

I. General information

NPI: 1861191256
Provider Name (Legal Business Name): JOHN MATTHEW SHARP LRIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATT SHARP CMHC, LPC

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 S 530 W
PAYSON UT
84651-3226
US

IV. Provider business mailing address

1039 S 530 W
PAYSON UT
84651-3226
US

V. Phone/Fax

Practice location:
  • Phone: 385-200-1083
  • Fax: 385-333-7151
Mailing address:
  • Phone: 757-679-3121
  • Fax: 385-333-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704015675
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: