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NPI Code Detail

MEDICARE: MATAJI ALLEN LPC

MEDICARE: MATAJI ALLEN LPC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorC5074OR
2101YP2500XProfessional CounselorC5074OR
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1811291164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATAJI ALLEN LPC
Provider Business Mailing Address
First Line : 300 W MAIN ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-2756
Country : US
Telephone Number : 541-772-1777
Fax Number : 541-724-2410
Provider Business Practice Location Address
First Line : 300 W MAIN ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-2756
Country : US
Telephone Number : 541-772-1777
Fax Number : 541-724-2410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2010
Last Update Date : 10/10/2023

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