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NPI Code Detail

MEDICARE: MS. MICHELLE EILEEN MATTINGLY

MEDICARE: MS. MICHELLE EILEEN MATTINGLY
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1124495254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE EILEEN MATTINGLY
Provider Business Mailing Address
First Line : 1526 REPUBLIC ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7016
Country : US
Telephone Number : 513-313-1608
Fax Number :
Provider Business Practice Location Address
First Line : 1526 REPUBLIC ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-7016
Country : US
Telephone Number : 513-242-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 12/11/2018

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Directions to “ MS. MICHELLE EILEEN MATTINGLY ” Practice Location

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