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General NPI Number Information
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NPI Number | 1962027532
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Entity Type | Individual
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Provider Name | MATTHEW USEDA LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1276 W RIVER ST
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City | BOISE
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State | ID
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Zip | 83702-7066
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Country | US
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Telephone | 208-338-4699
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Fax | 208-985-4135
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Provider Business Mailing Address
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Address Line | 1276 W RIVER ST STE 100
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City | BOISE
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State | ID
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Zip | 83702-7083
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Country | US
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Telephone | 208-338-4699
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Fax | 208-985-4135
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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 | T-21-546
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 20-QMHA-R-0445
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | L17407
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License Number State | ID
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