Individual
THERESA MATTISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1801 MICCOSUKEE CMNS # D, TALLAHASSEE, FL 32308-5433
(850) 488-0506
Mailing address
3550 ESPLANADE WAY APT 12213, TALLAHASSEE, FL 32311-3758
(716) 867-4689
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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