MEDICARE: MR. MATTHEW SCOTT GOTTULA PWS, PSS

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1588519243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW SCOTT GOTTULA PWS, PSS

Provider Business Mailing Address
First Line	:	7730 SE CENTER ST # A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-3327
Country	:	US
Telephone Number	:	503-944-9517
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 SE HIGHWAY 101 STE C
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-2773
Country	:	US
Telephone Number	:	503-308-2252
Fax Number	:

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

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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Directions to “ MR. MATTHEW SCOTT GOTTULA PWS, PSS” Practice Location

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