MEDICARE: DR. MATTHEW V. DAVIES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	113863-2501	UT
2	103TF0200X	Forensic Psychologist	113863-2501	UT

General Provider Information

NPI Number	:	1053409342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW V. DAVIES PH.D.

Provider Business Mailing Address
First Line	:	5353 S 960 E
Second Line	:	SUITE 230
City	:	MURRAY
State	:	UT
Zip	:	84117-3569
Country	:	US
Telephone Number	:	801-263-3335
Fax Number	:	801-263-2845

Provider Business Practice Location Address
First Line	:	5353 S 960 E
Second Line	:	SUITE 230
City	:	MURRAY
State	:	UT
Zip	:	84117-3569
Country	:	US
Telephone Number	:	801-263-3335
Fax Number	:	801-263-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/11/2025

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