Provider Demographics
NPI:1336293224
Name:MATTHEWS, LEE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:H
Last Name:MATTHEWS
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 1:5 PLATT DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1018
Mailing Address - Country:US
Mailing Address - Phone:504-450-1105
Mailing Address - Fax:504-469-8665
Practice Address - Street 1:5 PLATT DR
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1018
Practice Address - Country:US
Practice Address - Phone:504-450-1105
Practice Address - Fax:504-469-8665
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA485103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699012Medicaid
LA5S685Medicare PIN
LA5S6857627Medicare PIN