Healthcare Provider Details

I. General information

NPI: 1982903647
Provider Name (Legal Business Name): CLARISSA MATTHEWS PCC, LPCC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CLEVELAND AVE
FREMONT OH
43420-3224
US

IV. Provider business mailing address

715 S TAFT AVE
FREMONT OH
43420-3237
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-6619
  • Fax: 419-334-6663
Mailing address:
  • Phone: 419-334-6619
  • Fax: 419-334-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0500480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: