Healthcare Provider Details

I. General information

NPI: 1770446544
Provider Name (Legal Business Name): CATHERINE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 N 13TH AVE
OZARK MO
65721-6314
US

IV. Provider business mailing address

5608 N 13TH AVE
OZARK MO
65721-6314
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-6911
  • Fax:
Mailing address:
  • Phone: 417-581-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025010913
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: