Provider Demographics
NPI:1073668992
Name:MATTHEWS, SHEILA (PHD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W HAYS STREET
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5316
Mailing Address - Country:US
Mailing Address - Phone:208-383-1193
Mailing Address - Fax:208-336-9984
Practice Address - Street 1:1221 W HAYS STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5316
Practice Address - Country:US
Practice Address - Phone:208-383-1193
Practice Address - Fax:208-336-9984
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN9204OtherBLUE CROSS
ID000010016396OtherREGENCE BLUE SHIELD
168535Medicare ID - Type Unspecified