Provider Demographics
NPI:1831492834
Name:HENDRY, MATTHEW TRAVIS (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TRAVIS
Last Name:HENDRY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 EAST 400 SOUTH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663
Mailing Address - Country:US
Mailing Address - Phone:801-369-5060
Mailing Address - Fax:
Practice Address - Street 1:120 TILLSON AVE STE 214
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3400
Practice Address - Country:US
Practice Address - Phone:801-369-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional