MEDICARE: LATCHKEY COUNSELING PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1659963437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATCHKEY COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 209
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-0209
Country	:	US
Telephone Number	:	801-896-7146
Fax Number	:

Provider Business Practice Location Address
First Line	:	4630 S 3500 W STE 1
Second Line	:
City	:	WEST HAVEN
State	:	UT
Zip	:	84401-9401
Country	:	US
Telephone Number	:	801-896-7146
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	MR. MATT ALAN PETERSON
Credential	:	LCSW
Telephone Number	:	801-896-7146

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	03/27/2024

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