Provider Demographics
NPI:1093407223
Name:MATYI, JOSHUA (PHD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MATYI
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 1:988425 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8425
Mailing Address - Country:US
Mailing Address - Phone:402-552-6094
Mailing Address - Fax:402-552-7701
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-6094
Practice Address - Fax:402-552-7701
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1121103TC0700X, 103TH0100X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service