Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 330453-6004 | UT |
NPI | 1003136078 |
---|---|
Provider Name | Mr. David Alexander Matheson |
First Address | Holladay, UT 84124-2600 |
Second Address | Holladay, UT 84124-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2010 |
Last Update Date | 01/06/2010 |