Provider Demographics
NPI:1154691574
Name:MATTHEWS, SUSAN KAY
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N RANGELINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9100
Mailing Address - Country:US
Mailing Address - Phone:417-627-9601
Mailing Address - Fax:417-627-9032
Practice Address - Street 1:2700 N RANGELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9100
Practice Address - Country:US
Practice Address - Phone:417-627-9601
Practice Address - Fax:417-627-9032
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health