Doctor Name: | MR. MATTHEW RYAN MERBACK |
NPI Number: | 1811213622 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 292638-6004 |
Business Practice Address: | 49 E 200 S Clearfield, UT - 840151047 |
Business Phone Number: | 8017063034 |
Business Fax Number: | |
Mailing Address: | 49 E 200 S, CLEARFIELD |
State: | UT |
Postal Code: | 840151047 |
Phone Number: | 8017063034 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2010 |
NPI Last Update Date: | 03/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 292638-6004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |