Provider Demographics
NPI:1073662649
Name:MATHENY, RICHARD ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:MATHENY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108149 S 4803 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7681
Mailing Address - Country:US
Mailing Address - Phone:918-875-2920
Mailing Address - Fax:
Practice Address - Street 1:108149 S 4803 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-7681
Practice Address - Country:US
Practice Address - Phone:918-875-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OF34973OtherBLUE CROSS AND BLUE SHIELD (TRADITIONAL)
MI68OF34973OtherBLUE CROSS AND BLUE SHIELD (TRADITIONAL)