NPIMap

Individual provider Active NPI

Matthew Taylor Hedelius, PSY. D. LCSW

  • Mental Health Counselor
  • Logan, UT
National Provider Identifier
1053435289
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
322146-3501 Issued in UT
Practice address
40 W Cache Valley Blvd
#10A
Logan, UT 84341-8452
Phone
(435) 787-2272
Fax
(435) 713-4001
NPI assigned
Mar 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 322146-3501 UT Primary

Addresses

Primary practice location

40 W Cache Valley Blvd
#10A
Logan, UT 84341-8452

Mailing address

40 W Cache Valley Blvd
#10A
Logan, UT 84341-8452
Phone (435) 787-2272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
322146-3501UTMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Mental Health Services, PC Past Accepting new patients
Paradise Creek Recovery Center Inc Mental Health Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053435289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W CACHE VALLEY BLVD",
            "address_2": "#10A",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843418452",
            "telephone_number": "435-787-2272",
            "fax_number": "435-713-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 W CACHE VALLEY BLVD",
            "address_2": "#10A",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843418452",
            "telephone_number": "435-787-2272",
            "fax_number": "435-713-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEDELIUS",
        "first_name": "MATTHEW",
        "middle_name": "TAYLOR",
        "credential": "PSY. D. LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "UT",
            "license": "322146-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.