| Doctor Name: | MATT PETERSON |
| NPI Number: | 1407274897 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5554 S 3200 W Roy, UT - 840679718 |
| Business Phone Number: | 8014589793 |
| Business Fax Number: | |
| Mailing Address: | 5554 S 3200 W, ROY |
| State: | UT |
| Postal Code: | 840679718 |
| Phone Number: | 8014589793 |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2014 |
| NPI Last Update Date: | 04/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |