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NPI Code Detail

MEDICARE: TERRY MATHEWS LPC

MEDICARE: TERRY MATHEWS LPC
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
1101YP2500XProfessional CounselorLPC-23027AZ

General Provider Information

NPI Number : 1598375735
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY MATHEWS LPC
Provider Business Mailing Address
First Line : 1930 S ALMA SCHOOL RD STE A206
Second Line :
City : MESA
State : AZ
Zip : 85210-3066
Country : US
Telephone Number : 480-779-9050
Fax Number :
Provider Business Practice Location Address
First Line : 1930 S ALMA SCHOOL RD STE A206
Second Line :
City : MESA
State : AZ
Zip : 85210-3066
Country : US
Telephone Number : 480-779-9050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2020
Last Update Date : 05/12/2024

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