Provider Demographics
NPI:1295847838
Name:MATLAND, RICHARD OLIVER (MSW, LISW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:OLIVER
Last Name:MATLAND
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24589 INGRUM AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-6285
Mailing Address - Country:US
Mailing Address - Phone:712-527-9373
Mailing Address - Fax:712-527-9373
Practice Address - Street 1:601 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-4242
Practice Address - Country:US
Practice Address - Phone:712-323-1728
Practice Address - Fax:712-323-8888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health