Healthcare Provider Details
I. General information
NPI: 1861357972
Provider Name (Legal Business Name): THE ECLECTIC NEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
558 W UWCHLAN AVE STE 2B
EXTON PA
19341-3050
US
IV. Provider business mailing address
558 W UWCHLAN AVE STE 2B
EXTON PA
19341-3050
US
V. Phone/Fax
- Phone: 610-482-4496
- Fax: 484-873-3903
- Phone: 610-482-4496
- Fax: 484-873-3903
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JESSE
MATTHEWS
Title or Position: PSYCHOLOGIST AND OWNER
Credential: PSYD
Phone: 610-482-4496