Provider Demographics
NPI:1164453031
Name:MATHIS, MADELEINE ALVA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:ALVA
Last Name:MATHIS
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:2801 CORNHUSKER HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1545
Mailing Address - Country:US
Mailing Address - Phone:402-473-2808
Mailing Address - Fax:402-466-5085
Practice Address - Street 1:2801 CORNHUSKER HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1545
Practice Address - Country:US
Practice Address - Phone:402-473-2808
Practice Address - Fax:402-466-5085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NE478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical