Individual
MATTHEW ELMO JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21360 N 1450 E, MORONI, UT 84646-0461
(435) 445-5200
(435) 445-5201
Mailing address
PO BOX 461, MORONI, UT 84646-0461
(435) 445-5200
(435) 445-5201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/25/2012
Last updated
01/25/2012
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