Provider Demographics
NPI:1053409342
Name:DAVIES, MATTHEW V (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:V
Last Name:DAVIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 S 960 E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3569
Mailing Address - Country:US
Mailing Address - Phone:801-263-3335
Mailing Address - Fax:801-263-2845
Practice Address - Street 1:5353 S 960 E
Practice Address - Street 2:SUITE 230
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3569
Practice Address - Country:US
Practice Address - Phone:801-263-3335
Practice Address - Fax:801-263-2845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113863-2501103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic