Provider Demographics
NPI:1053435289
Name:HEDELIUS, MATTHEW TAYLOR (PSY D LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TAYLOR
Last Name:HEDELIUS
Suffix:
Gender:M
Credentials:PSY D LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W CACHE VALLEY BLVD
Mailing Address - Street 2:#10A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-8452
Mailing Address - Country:US
Mailing Address - Phone:435-787-2272
Mailing Address - Fax:435-713-4001
Practice Address - Street 1:40 W CACHE VALLEY BLVD
Practice Address - Street 2:#10A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-8452
Practice Address - Country:US
Practice Address - Phone:435-787-2272
Practice Address - Fax:435-713-4001
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322146-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health