1467973990 NPI number — DR. JUDITH JEANNE MATHEWSON PH.D.

Table of content: DR. JUDITH JEANNE MATHEWSON PH.D. (NPI 1467973990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467973990 NPI number — DR. JUDITH JEANNE MATHEWSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWSON
Provider First Name:
JUDITH
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467973990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6672
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN BUREN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72956-0601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-243-3376
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHENAL FAMILY THERAPY, PLC
Provider Second Line Business Practice Location Address:
5111 ROGERS AVE, STE 561, CENTRAL PLAZA SUITES
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72903-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-595-0333
Provider Business Practice Location Address Fax Number:
888-816-7916
Provider Enumeration Date:
07/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH16768 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: P1911140 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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