=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255570115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW MENDEL, PH.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2009
-----------------------------------------------------
Last Update Date | 02/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3727 BENSON DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-7324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-876-1313
-----------------------------------------------------
Fax | 919-882-1567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3727 BENSON DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-7324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-876-1313
-----------------------------------------------------
Fax | 919-882-1567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MATTHEW MENDEL
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 919-876-1313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 7167
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2156
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------