Individual provider Active NPI

Matthew Januzik, PSYD

  • Psychologist
  • Salt Lake City, UT
National Provider Identifier
1376187898
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
13683030-2504 Issued in UT
Practice address
170 S 1000 E Ste 201
Salt Lake City, UT 84102-1403
Phone
(801) 419-0139
NPI assigned
Oct 29, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 13683030-2504 UT Primary

Addresses

Primary practice location

170 S 1000 E Ste 201
Salt Lake City, UT 84102-1403

Mailing address

170 S 1000 E Ste 201
Salt Lake City, UT 84102-1403
Phone (801) 419-0139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 3, 2026 through Mar 3, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13683030-2504UTMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wasatch Behavioral Health Special Service District CurrentSince Jan 9, 2024 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince Jan 9, 2024 Accepting new patients
Fuller Psychological and Family Services Student in an Organized Health Care Education/Training Program PastSince Nov 1, 2019 Accepting new patients

Locations

750 N Freedom Blvd
Provo, UT 84601
Phone (801) 373-0639

750 N Freedom Blvd
Ste 300
Provo, UT 84601
Phone (801) 373-4763

Organizations & group practices 3

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": "1572307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1376187898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 S 1000 E STE 201",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021403",
            "telephone_number": "801-419-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 S 1000 E STE 201",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021403",
            "telephone_number": "801-419-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANUZIK",
        "first_name": "MATTHEW",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-29",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "13683030-2504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.