Healthcare Provider Details

I. General information

NPI: 1982058137
Provider Name (Legal Business Name): MATILDA DAY RN, MA, LPC C4746
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 FALCON CREST DR STE 200
REDMOND OR
97756-5023
US

IV. Provider business mailing address

PO BOX 220
POWELL BUTTE OR
97753-0220
US

V. Phone/Fax

Practice location:
  • Phone: 971-599-0694
  • Fax: 458-312-1500
Mailing address:
  • Phone: 971-599-0694
  • Fax: 458-312-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4746
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: