Provider Demographics
NPI:1457192643
Name:PSYCH MATTER PLLC
Entity type:Organization
Organization Name:PSYCH MATTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAUN
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMS, CAQ-PSY, PA-C
Authorized Official - Phone:801-663-1929
Mailing Address - Street 1:2130 E 2200 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040
Mailing Address - Country:US
Mailing Address - Phone:801-663-1929
Mailing Address - Fax:877-559-3988
Practice Address - Street 1:2130 E 2200 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040
Practice Address - Country:US
Practice Address - Phone:801-663-1929
Practice Address - Fax:877-559-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty