Individual
ANNAMARIE H MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, MSW, LCSW
Contact information
Practice address
351 S MAIN ST # 23, JEFFERSON, OR 97352-9401
(541) 905-8173
Mailing address
760 TERRITORIAL ST, HARRISBURG, OR 97446-9554
(971) 301-2189
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
L10905
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500705747
—
OR
Enumeration date
03/25/2015
Last updated
05/13/2025
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