Provider Demographics
NPI:1033581368
Name:MATOTEK, JACQUELYN MICHELLE (MA,NCC, LPC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MICHELLE
Last Name:MATOTEK
Suffix:
Gender:F
Credentials:MA,NCC, LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-2373
Mailing Address - Country:US
Mailing Address - Phone:724-622-5471
Mailing Address - Fax:
Practice Address - Street 1:250 INSURANCE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2760
Practice Address - Country:US
Practice Address - Phone:724-371-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional