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General NPI Number Information
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NPI Number | 1922246909
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Entity Type | Individual
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Provider Name | JOHN M MATUS LMSW, CAADC, CFAE
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Gender | Male
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 420 W 5TH AVE
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City | FLINT
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State | MI
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Zip | 48503-2445
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Country | US
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Telephone | 810-424-6087
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Fax |
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Provider Business Mailing Address
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Address Line | 295 COUTANT ST
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City | FLUSHING
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State | MI
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Zip | 48433-1505
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Country | US
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Telephone | 810-659-3630
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C00685
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801087780
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License Number State | MI
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