Individual
MARTHA LEE MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PHD, HSPP
Contact information
Practice address
421 W 1ST ST, BLOOMINGTON, IN 47403-2403
(812) 336-0168
Mailing address
421 W 1ST ST, BLOOMINGTON, IN 47403-2403
(812) 336-0168
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001205A
IN
103TC1900X
Counseling Psychologist
Primary
20041513A
IN
163W00000X
Registered Nurse
28043229A
IN
Other
Enumeration date
07/03/2006
Last updated
05/20/2010
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