Healthcare Provider Details

I. General information

NPI: 1396994927
Provider Name (Legal Business Name): LUKE CHARLES MATTEUCCI MS, MA, NCC, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710C FOOTHILLS DR STE 104
NEWBERG OR
97132-6124
US

IV. Provider business mailing address

1009 SE EDWARDS DR
DUNDEE OR
97115-9601
US

V. Phone/Fax

Practice location:
  • Phone: 971-732-3929
  • Fax:
Mailing address:
  • Phone: 971-732-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3379
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNCC 265054
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMAC 507626
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: