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General NPI Number Information
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NPI Number | 1295847838
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Entity Type | Individual
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Provider Name | RICHARD OLIVER MATLAND MSW, LISW
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 601 WILLOW AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-4242
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Country | US
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Telephone | 712-323-1728
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Fax | 712-323-8888
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Provider Business Mailing Address
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Address Line | 24589 INGRUM AVE
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City | GLENWOOD
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State | IA
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Zip | 51534-6285
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Country | US
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Telephone | 712-527-9373
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Fax | 712-527-9373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 00457
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License Number State | IA
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