Healthcare Provider Details

I. General information

NPI: 1104749084
Provider Name (Legal Business Name): CARL WAYNE MATHEWS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 SAINT JOSEPH ST STE 205
RAPID CITY SD
57701-5002
US

IV. Provider business mailing address

731 SAINT JOSEPH ST STE 205
RAPID CITY SD
57701-5002
US

V. Phone/Fax

Practice location:
  • Phone: 605-721-0200
  • Fax:
Mailing address:
  • Phone: 605-721-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: