Individual
MR. AUSTIN RAY MATTHIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2617 GENERAL PERSHING BLVD, OKLAHOMA CITY, OK 73107-6437
(405) 858-2957
Mailing address
PO BOX 12978, OKLAHOMA CITY, OK 73157-2978
(405) 858-2957
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11897
OK
Other
Enumeration date
09/22/2021
Last updated
03/27/2024
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