Healthcare Provider Details

I. General information

NPI: 1255629572
Provider Name (Legal Business Name): MATTHEW ROY ATKINS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 08/16/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 YORK AVE S STE 620
MINNEAPOLIS MN
55435-2347
US

IV. Provider business mailing address

6041 5TH AVE S
MINNEAPOLIS MN
55419-2513
US

V. Phone/Fax

Practice location:
  • Phone: 970-270-3784
  • Fax:
Mailing address:
  • Phone: 970-270-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36605
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: