Provider Demographics
NPI:1356390975
Name:MATHEWS, JULIA ANN (PSYCH)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 L ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3470
Mailing Address - Country:US
Mailing Address - Phone:801-534-1517
Mailing Address - Fax:
Practice Address - Street 1:2118 E 3900 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1775
Practice Address - Country:US
Practice Address - Phone:801-277-7524
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108131-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling