Healthcare Provider Details

I. General information

NPI: 1326385733
Provider Name (Legal Business Name): ANN MAURINE MATNEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 OAK ST STE 205
BOZEMAN MT
59715-8757
US

IV. Provider business mailing address

2050 FAIRWAY DR STE 107
BOZEMAN MT
59715-5819
US

V. Phone/Fax

Practice location:
  • Phone: 406-581-1138
  • Fax:
Mailing address:
  • Phone: 406-581-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberLMT-LMT-LIC-1049
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: