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General NPI Number Information
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NPI Number | 1750829768
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Entity Type | Organization
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Legal Business Name | MATTIS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 4520 OLD WILLIAM PENN HWY SUITE B
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City | MURRYSVILLE
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State | PA
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Zip | 15668-1930
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Country | US
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Telephone | 814-279-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 OLD WILLIAM PENN HWY SUITE B
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City | MURRYSVILLE
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State | PA
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Zip | 15668-1930
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Country | US
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Telephone | 814-279-0739
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE MATTIS
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Credential | PSYD
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Telephone | 814-279-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017844
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License Number State | PA
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