Active NPI
Matthew Ryan Merback, LPC
- Mental Illness Community Based Residential Treatment Facility
- Clearfield, UT
National Provider Identifier
1811213622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- 292638-6004
- Practice address
- 49 E 200 S
Clearfield, UT 84015-1047 - Phone
- (801) 706-3034
- NPI assigned
- Apr 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 292638-6004 | UT | Primary |
Addresses
Primary practice location
49 E 200 S
Clearfield, UT 84015-1047
Mailing address
49 E 200 S
Clearfield, UT 84015-1047
Phone (801) 706-3034
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
| License | State | Type | Specialty |
|---|---|---|---|
| 292638-6004 | UT | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426723200000",
"number": "1811213622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 E 200 S",
"city": "CLEARFIELD",
"state": "UT",
"postal_code": "840151047",
"telephone_number": "801-706-3034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 E 200 S",
"city": "CLEARFIELD",
"state": "UT",
"postal_code": "840151047",
"telephone_number": "801-706-3034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERBACK",
"first_name": "MATTHEW",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-19",
"last_updated": "2015-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "UT",
"license": "292638-6004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearfield, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.