Healthcare Provider Details

I. General information

NPI: 1467973990
Provider Name (Legal Business Name): JUDITH JEANNE MATHEWSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHENAL FAMILY THERAPY, PLC 5111 ROGERS AVE, STE 561, CENTRAL PLAZA SUITES
FORT SMITH AR
72903-2047
US

IV. Provider business mailing address

PO BOX 6672
VAN BUREN AR
72956-0601
US

V. Phone/Fax

Practice location:
  • Phone: 479-595-0333
  • Fax: 888-816-7916
Mailing address:
  • Phone: 321-243-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16768
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1911140
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: