Provider Demographics
NPI:1639693344
Name:DIXIE STATE UNIVERSITY HEALTH & COUNSELING CENTER
Entity Type:Organization
Organization Name:DIXIE STATE UNIVERSITY HEALTH & COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUMORI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-652-7756
Mailing Address - Street 1:1037 E 100 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3006
Mailing Address - Country:US
Mailing Address - Phone:435-652-7756
Mailing Address - Fax:
Practice Address - Street 1:1037 E 100 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3006
Practice Address - Country:US
Practice Address - Phone:435-652-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIXIE STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1244136008101YA0400X
UT91334252501103T00000X
UT13514535011041C0700X
UT3288013102163W00000X
261QS1000X
UT7343133-4405363L00000X
UT50390644405363L00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty