Provider Demographics
NPI:1710701396
Name:MATHEWS, JUSTIN DELL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DELL
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 S WILLOW HILLS CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1889
Mailing Address - Country:US
Mailing Address - Phone:385-505-3535
Mailing Address - Fax:
Practice Address - Street 1:250 N OREM BLVD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6601
Practice Address - Country:US
Practice Address - Phone:801-609-2448
Practice Address - Fax:801-609-2447
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11567335-8900363LP0808X
UT11567335-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health