Healthcare Provider Details

I. General information

NPI: 1295433266
Provider Name (Legal Business Name): MATTHEW VALENTINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N MALL DR
SAINT GEORGE UT
84790-7302
US

IV. Provider business mailing address

321 N MALL DR
SAINT GEORGE UT
84790-7302
US

V. Phone/Fax

Practice location:
  • Phone: 435-359-2404
  • Fax:
Mailing address:
  • Phone: 435-359-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14046044-3902
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberINTERN
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: