Doctor Name: | MR. DAVID ALEXANDER MATHESON |
NPI Number: | 1003136078 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 330453-6004 |
Business Practice Address: | 4190 Highland Dr Suite 100 Holladay, UT - 841242600 |
Business Phone Number: | 8012723200 |
Business Fax Number: | 8012723416 |
Mailing Address: | 4190 Highland Dr, Suite 100 HOLLADAY |
State: | UT |
Postal Code: | 841242600 |
Phone Number: | 8012723200 |
Fax Number: | 8012723416 |
NPI Enumeration Date: | 06/01/2010 |
NPI Last Update Date: | 06/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 330453-6004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |