Provider Demographics
NPI:1073767158
Name:MATHEWS, JUDITH (MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 CAUGHLIN PKWY
Mailing Address - Street 2:STE. #11
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0906
Mailing Address - Country:US
Mailing Address - Phone:775-324-1316
Mailing Address - Fax:775-329-5563
Practice Address - Street 1:4747 CAUGHLIN PKWY
Practice Address - Street 2:STE. #11
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0906
Practice Address - Country:US
Practice Address - Phone:775-324-1316
Practice Address - Fax:775-329-5563
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist