Individual
DR. JENNY M MATTHAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.D
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
HSP 1753
TN
103T00000X
Psychologist
Primary
P1753
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3983054
—
TN
01
—
4070500
BCBS - NONPARTICIPATING
TN
Enumeration date
10/19/2006
Last updated
06/24/2011
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