Healthcare Provider Details

I. General information

NPI: 1730628421
Provider Name (Legal Business Name): EVAN MATHENEY LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

IV. Provider business mailing address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-3232
  • Fax:
Mailing address:
  • Phone: 330-264-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: