Provider Demographics
NPI:1093855520
Name:MATTHEWS, WILLIAM BRYAN (MS, CRC, LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRYAN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17051 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-8222
Mailing Address - Country:US
Mailing Address - Phone:573-265-1959
Mailing Address - Fax:
Practice Address - Street 1:13160 CO RD 3610
Practice Address - Street 2:BOYS AND GIRLS TOWN OF MISSOURI
Practice Address - City:ST. JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-0189
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-5310
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional