MEDICARE: MR. ROBERT E MATHEWS LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1089	OK

General Provider Information

NPI Number	:	1972764991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT E MATHEWS LADC

Provider Business Mailing Address
First Line	:	5319 S LEWIS
Second Line	:	STE 219
City	:	TULSA
State	:	OK
Zip	:	74105
Country	:	US
Telephone Number	:	918-832-7763
Fax Number	:	918-292-8250

Provider Business Practice Location Address
First Line	:	5913 S LEWIS
Second Line	:	STE 219
City	:	TULSA
State	:	OK
Zip	:	74105
Country	:	US
Telephone Number	:	918-832-7763
Fax Number	:	918-292-8250

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	04/04/2016

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