Healthcare Provider Details

I. General information

NPI: 1578499661
Provider Name (Legal Business Name): MATTHEW TUMUA SIUFANUA JR. AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W CENTER ST
PLEASANT GROVE UT
84062-2207
US

IV. Provider business mailing address

135 W CENTER ST
PLEASANT GROVE UT
84062-2207
US

V. Phone/Fax

Practice location:
  • Phone: 801-785-1169
  • Fax:
Mailing address:
  • Phone: 801-785-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14098845-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: