MEDICARE: MATISON WILLIAM MCCOOL

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	103T00000X	Psychologist	PSY-2025-0048	NM

General Provider Information

NPI Number	:	1831024330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATISON WILLIAM MCCOOL

Provider Business Mailing Address
First Line	:	4405 JAGER DR NE STE C4-4262
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5709
Country	:	US
Telephone Number	:	505-228-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	9649 ASBURY LN NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4344
Country	:	US
Telephone Number	:	505-228-0142
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ MATISON WILLIAM MCCOOL ” Practice Location

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