Provider Demographics
NPI:1225560055
Name:CLEM, MATTHEW (PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CLEM
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 1:11882 GREENVILLE AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3567
Mailing Address - Country:US
Mailing Address - Phone:972-644-8686
Mailing Address - Fax:972-644-8688
Practice Address - Street 1:6363 FOREST PARK RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5479
Practice Address - Country:US
Practice Address - Phone:214-648-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist