Individual
MARK MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1233 E MOUNT PLEASANT RD APT 504, ZACHARY, LA 70791
(225) 361-4723
Mailing address
1233 E MOUNT PLEASANT RD APT 504, ZACHARY, LA 70791-5928
(225) 361-4723
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
LA
Enumeration date
04/04/2017
Last updated
05/15/2018
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