Provider Demographics
NPI:1215957840
Name:MATTHEWS, THOMAS V (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 SW 29TH ST # 102
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2085
Mailing Address - Country:US
Mailing Address - Phone:785-273-5373
Mailing Address - Fax:785-273-1373
Practice Address - Street 1:2709 SW 29TH ST # 102
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2085
Practice Address - Country:US
Practice Address - Phone:785-273-5373
Practice Address - Fax:785-273-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4957118603Medicaid
KSR31961Medicare UPIN
KS022114Medicare ID - Type Unspecified