Healthcare Provider Details

I. General information

NPI: 1184231854
Provider Name (Legal Business Name): MATTHEW C BOTE CT CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 450
EUGENE OR
97401-8164
US

IV. Provider business mailing address

7344 PEARL RD STE 2B
MIDDLEBURG HEIGHTS OH
44130-9602
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7131
  • Fax: 458-205-7061
Mailing address:
  • Phone: 440-625-0081
  • Fax: 440-625-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.173389
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10024
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: