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NPI Code Detail

MEDICARE: MR. MATTHEW WAYNE RAULSTON LCSW

MEDICARE:  MR. MATTHEW WAYNE RAULSTON  LCSW
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
11041C0700XClinical Social Worker7050OK

General Provider Information

NPI Number : 1942683461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW WAYNE RAULSTON LCSW
Provider Business Mailing Address
First Line : 6216 S LEWIS AVE STE 102
Second Line :
City : TULSA
State : OK
Zip : 74136-1075
Country : US
Telephone Number : 918-268-7263
Fax Number :
Provider Business Practice Location Address
First Line : 6216 S LEWIS AVE STE 102
Second Line :
City : TULSA
State : OK
Zip : 74136-1075
Country : US
Telephone Number : 918-268-7263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2015
Last Update Date : 01/16/2026

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Directions to “ MR. MATTHEW WAYNE RAULSTON LCSW” Practice Location

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