MEDICARE: MS. ANITA J MATHENY LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	933413	OH

General Provider Information

NPI Number	:	1013202415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA J MATHENY LICDC

Provider Business Mailing Address
First Line	:	1856 CEDAR HILL ROAD
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-4178
Country	:	US
Telephone Number	:	740-687-4500
Fax Number	:	740-687-4595

Provider Business Practice Location Address
First Line	:	1856 CEDAR HILL ROAD
Second Line	:
City	:	LANCASTER
State	:	OH
Zip	:	43130-4178
Country	:	US
Telephone Number	:	740-687-4500
Fax Number	:	740-687-4595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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