Provider Demographics
NPI:1972931079
Name:MATURY, MICHELLE (MHS, CADC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MATURY
Suffix:
Gender:F
Credentials:MHS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 RAVEN CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-7207
Mailing Address - Country:US
Mailing Address - Phone:219-306-9398
Mailing Address - Fax:
Practice Address - Street 1:3155 E PATRICK LN STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3481
Practice Address - Country:US
Practice Address - Phone:702-992-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00374-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)