Provider Demographics
NPI:1346676640
Name:SEELOS, MATTHEW JERALD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JERALD
Last Name:SEELOS
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 1:639 ROSE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4258
Mailing Address - Country:US
Mailing Address - Phone:801-824-5355
Mailing Address - Fax:
Practice Address - Street 1:639 ROSE BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4258
Practice Address - Country:US
Practice Address - Phone:801-824-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT491310035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical