Provider Demographics
NPI:1093879595
Name:MATTHEWS, CALVIN O (PHD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:O
Last Name:MATTHEWS
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:PO BOX 11791
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-1791
Mailing Address - Country:US
Mailing Address - Phone:256-837-2127
Mailing Address - Fax:
Practice Address - Street 1:936 JEFF RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-1238
Practice Address - Country:US
Practice Address - Phone:256-837-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51033906MATOtherBLUE CROSS&BLUE SHIELD
ALA10565Medicare UPIN