Doctor Name: | CODY MATHESON |
NPI Number: | 1114193877 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 54 N 200 E Cedar City, UT - 847202615 |
Business Phone Number: | 4355862515 |
Business Fax Number: | 4358657606 |
Mailing Address: | 474 W 200 N, Ste#300 ST GEORGE |
State: | UT |
Postal Code: | 847704505 |
Phone Number: | 4356345600 |
Fax Number: | 4359868700 |
NPI Enumeration Date: | 05/02/2008 |
NPI Last Update Date: | 05/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |