Marvon Shane Holdaway, CM

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Practice address

265 N State St
Mount Pleasant, UT 84647-1108

Phone

(435) 462-2781

Fax

(435) 462-0155

NPI assigned

Jul 15, 2022

Last updated

Jul 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Matr, Inc.

  dba MATR Behavioral Health

  • Substance Abuse Rehabilitation Facility
  • Mt Pleasant, UT
  • NPI 1700177409
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1053045898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31",
            "city": "MT PLEASANT",
            "state": "UT",
            "postal_code": "846470031",
            "telephone_number": "435-462-2781",
            "fax_number": "435-462-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 N STATE ST",
            "city": "MOUNT PLEASANT",
            "state": "UT",
            "postal_code": "846471108",
            "telephone_number": "435-462-2781",
            "fax_number": "435-462-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDAWAY",
        "first_name": "MARVON",
        "middle_name": "SHANE",
        "credential": "CM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-15",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HT007021-001",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matrinc@cut.net",
            "affiliation": "N",
            "endpointDescription": "business email",
            "address_1": "265 N State St",
            "city": "Mount Pleasant",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846471108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Clark Hawk, LCSW
• Linda Healy, R.N.
• Richard Pratt Heilbut, CPSS
• Jennifer J Hobby, CSW
• Deaun Larson Holdaway, UNLICENSED PROVIDER
• Craig S Humes, PA
• Nathan S Huntington, D.D.S.
• Ihc Health Services (IMED HSA Sanpete)
• Ihc Health Services Inc (Sanpete Hospitalist)
• Ihc Health Services Inc (Cardiac Imaging - Mt Pleasant)

• Substance Use Disorder Rehabilitation Clinic/Center in Mt Pleasant, UT
• Providers in Mt Pleasant, UT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.