Healthcare Provider Details

I. General information

NPI: 1356390975
Provider Name (Legal Business Name): JULIA ANN MATHEWS PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 E 3900 S SUITE 100
SALT LAKE CITY UT
84124-1775
US

IV. Provider business mailing address

80 L ST
SALT LAKE CITY UT
84103-3470
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-7524
  • Fax:
Mailing address:
  • Phone: 801-534-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number108131-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: