=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376405027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW ALLEN HOULE PASTORPEERSPECIALIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 7TH AVE S
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58227-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-659-1519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 7TH AVE S
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58227-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-659-1519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374K00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Practitioner
-----------------------------------------------------
License Number | 131571
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | 253
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------