Provider Demographics
NPI:1154864205
Name:MATTHEW N. KOURY, MD, MPH A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MATTHEW N. KOURY, MD, MPH A PROFESSIONAL CORPORATION
Other - Org Name:MIND HEALTH INSTITUTE, NEWPORT BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:949-891-0307
Mailing Address - Street 1:450 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7610
Mailing Address - Country:US
Mailing Address - Phone:949-891-0307
Mailing Address - Fax:800-217-8204
Practice Address - Street 1:450 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 380
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7610
Practice Address - Country:US
Practice Address - Phone:949-891-0307
Practice Address - Fax:800-217-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99131101YM0800X
CAA91131103TC0700X, 106H00000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty