Healthcare Provider Details

I. General information

NPI: 1477923423
Provider Name (Legal Business Name): STEVEN MATES PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2015
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 LINCOLN PARK BLVD STE 344
KETTERING OH
45429-3493
US

IV. Provider business mailing address

580 LINCOLN PARK BLVD STE 344
KETTERING OH
45429-3493
US

V. Phone/Fax

Practice location:
  • Phone: 937-401-0144
  • Fax: 937-496-5480
Mailing address:
  • Phone: 937-401-0144
  • Fax: 937-496-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.18078
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.18078.NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: