Provider Demographics
NPI:1023373305
Name:CHECKETTS, MATTHEW BRENT (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRENT
Last Name:CHECKETTS
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3277
Mailing Address - Country:US
Mailing Address - Phone:801-874-4899
Mailing Address - Fax:
Practice Address - Street 1:240 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3277
Practice Address - Country:US
Practice Address - Phone:801-874-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4873893-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical