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General NPI Number Information
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NPI Number | 1255681599
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Entity Type | Individual
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Provider Name | MR. BRAD ALEXANDER MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 3051 W MAPLE LOOP DR STE 210
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City | LEHI
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State | UT
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Zip | 84043-4602
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Country | US
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Telephone | 801-432-0991
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 W MAPLE LOOP DR STE 210
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City | LEHI
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State | UT
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Zip | 84043-4602
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Country | US
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Telephone | 801-432-0991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 12566979-3502
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License Number State | UT
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