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NPI Code Detail

MEDICARE: DR. DESTINEE MATTHEWS M.S.

MEDICARE: DR. DESTINEE MATTHEWS M.S.
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
1101Y00000XCounselorPLC9261LA
2171M00000XCase Manager/Care CoordinatorPLC9261LA
3171M00000XCase Manager/Care Coordinator
4101YP2500XProfessional Counselor9261LA

General Provider Information

NPI Number : 1174989610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DESTINEE MATTHEWS M.S.
Provider Business Mailing Address
First Line : 617 E MADISON AVE
Second Line :
City : BASTROP
State : LA
Zip : 71220-3833
Country : US
Telephone Number : 318-239-3890
Fax Number : 318-239-3891
Provider Business Practice Location Address
First Line : 617 E MADISON AVE
Second Line :
City : BASTROP
State : LA
Zip : 71220-3833
Country : US
Telephone Number : 318-239-3890
Fax Number : 318-239-3891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2016
Last Update Date : 01/22/2025

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