MEDICARE: KATHERINE MATTHEWS MFT-I

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	106H00000X	Marriage & Family Therapist	NV20151065225	NV

General Provider Information

NPI Number	:	1235587189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MATTHEWS MFT-I

Provider Business Mailing Address
First Line	:	8565 S EASTERN AVE
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2808
Country	:	US
Telephone Number	:	702-708-1081
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE
Second Line	:	SUITE 116
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2808
Country	:	US
Telephone Number	:	702-708-1081
Fax Number	:

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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