Provider Demographics
NPI:1699344457
Name:MATSON, EMILY KATHRYN (MS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:MATSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1768
Mailing Address - Country:US
Mailing Address - Phone:518-466-4972
Mailing Address - Fax:
Practice Address - Street 1:304 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1768
Practice Address - Country:US
Practice Address - Phone:518-466-4972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health