Healthcare Provider Details

I. General information

NPI: 1093293441
Provider Name (Legal Business Name): CHELSEA LYNN MATTESON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2018
Last Update Date: 06/27/2023
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21803 N SCOTTSDALE RD STE 105
SCOTTSDALE AZ
85255-7444
US

IV. Provider business mailing address

21803 N SCOTTSDALE RD STE 105
SCOTTSDALE AZ
85255-7444
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-0593
  • Fax:
Mailing address:
  • Phone: 480-630-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005383
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: