Healthcare Provider Details

I. General information

NPI: 1093855520
Provider Name (Legal Business Name): WILLIAM BRYAN MATTHEWS M.S., C.R.C., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 KINGSHIGHWAY ST STE 5
ROLLA MO
65401-2981
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-8511
  • Fax: 573-364-4931
Mailing address:
  • Phone: 417-761-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002010848
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: