Provider Demographics
NPI:1952001463
Name:WRIGHT, MATTHEW C (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1138
Mailing Address - Country:US
Mailing Address - Phone:801-318-8100
Mailing Address - Fax:
Practice Address - Street 1:45 W MAIN STREET CT STE 255
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-5700
Practice Address - Country:US
Practice Address - Phone:385-446-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10434603-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health