Provider Demographics
NPI:1306356522
Name:MATOVU, EDWARD (LMHC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:MATOVU
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 BROOK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2347
Mailing Address - Country:US
Mailing Address - Phone:781-308-7619
Mailing Address - Fax:
Practice Address - Street 1:3261 BROOK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-2347
Practice Address - Country:US
Practice Address - Phone:781-308-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty