Provider Demographics
NPI:1467973990
Name:MATHEWSON, JUDITH JEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:JEANNE
Last Name:MATHEWSON
Suffix:
Gender:F
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:PO BOX 6672
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-0601
Mailing Address - Country:US
Mailing Address - Phone:321-243-3376
Mailing Address - Fax:
Practice Address - Street 1:CHENAL FAMILY THERAPY, PLC
Practice Address - Street 2:5111 ROGERS AVE, STE 561, CENTRAL PLAZA SUITES
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2047
Practice Address - Country:US
Practice Address - Phone:479-595-0333
Practice Address - Fax:888-816-7916
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16768101YM0800X
ARP1911140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health