1548619679 NPI number — VICKI MARIE MATTHEWS M.A., LPCC

Table of content: VICKI MARIE MATTHEWS M.A., LPCC (NPI 1548619679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548619679 NPI number — VICKI MARIE MATTHEWS M.A., LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
VICKI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTHEWS
Provider Other First Name:
VICKI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. LPCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548619679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1354
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELEPHANT BUTTE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87935-1354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-520-1919
Provider Business Mailing Address Fax Number:
575-520-1919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N DATE ST STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUTH OR CONSEQUENCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87901-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-520-1919
Provider Business Practice Location Address Fax Number:
575-520-1919
Provider Enumeration Date:
06/09/2016

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: 101YP2500X , with the licence number:  8817 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: CCMH0220321 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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