Individual
TERRY MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1045 CHURCH RD E, SOUTHAVEN, MS 38671-9702
(901) 413-2779
Mailing address
1045 CHURCH RD E, SOUTHAVEN, MS 38671-9702
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T0291
MS
Other
Enumeration date
05/19/2020
Last updated
05/19/2020
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