Provider Demographics
NPI:1407949696
Name:ATTEBERRY, MATTHEW MANSON (LSCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MANSON
Last Name:ATTEBERRY
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:1730 BELMONT
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0258
Mailing Address - Country:US
Mailing Address - Phone:620-421-3770
Mailing Address - Fax:620-421-0665
Practice Address - Street 1:1730 BELMONT
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-0258
Practice Address - Country:US
Practice Address - Phone:620-421-3770
Practice Address - Fax:620-421-0665
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1567104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS044755OtherBLUE CROSS BLUE SHIELD
KS044755OtherBLUE CROSS BLUE SHIELD