MEDICARE: MRS. TATIANA Y. MATTHEWS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	003359	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00359	OTHER	GA	LPC

General Provider Information

NPI Number	:	1053321687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TATIANA Y. MATTHEWS MS

Provider Business Mailing Address
First Line	:	17 BALL CREEK WAY
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-4467
Country	:	US
Telephone Number	:	770-815-6853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 MOUNT VERNON RD STE G
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-4245
Country	:	US
Telephone Number	:	707-815-6853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	03/08/2024

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