Provider Demographics
NPI:1396994927
Name:MATTEUCCI, LUKE CHARLES (MS, MA, NCC, MAC)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:CHARLES
Last Name:MATTEUCCI
Suffix:
Gender:M
Credentials:MS, MA, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SE EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-9601
Mailing Address - Country:US
Mailing Address - Phone:971-732-6614
Mailing Address - Fax:
Practice Address - Street 1:710C FOOTHILLS DR STE 104
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6124
Practice Address - Country:US
Practice Address - Phone:971-732-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3379101YP2500X
ORNCC 265054101Y00000X
ORMAC 507626101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)