Provider Demographics
NPI:1063632628
Name:MATEYKO, CARRIE LOUISE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:LOUISE
Last Name:MATEYKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 LESCAR LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8536
Mailing Address - Country:US
Mailing Address - Phone:614-620-3232
Mailing Address - Fax:
Practice Address - Street 1:860 LESCAR LN
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8536
Practice Address - Country:US
Practice Address - Phone:614-620-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional