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General NPI Number Information
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NPI Number | 1558236554
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Entity Type | Individual
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Provider Name | MICHAEL B MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 1309 BENNETT AVE
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City | BURLEY
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State | ID
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Zip | 83318-2676
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Country | US
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Telephone | 208-678-7796
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Fax | 385-236-7291
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Provider Business Mailing Address
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Address Line | 2465 HILAND AVE APT D308
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City | BURLEY
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State | ID
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Zip | 83318-2779
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Country | US
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Telephone | 385-236-7291
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Fax | 385-236-7291
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3371880
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3371880
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3371880
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License Number State | ID
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