Provider Demographics
NPI:1477923423
Name:MATES, STEVEN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:MATES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 POE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2552
Mailing Address - Country:US
Mailing Address - Phone:937-280-2000
Mailing Address - Fax:937-280-2051
Practice Address - Street 1:7695 POE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2552
Practice Address - Country:US
Practice Address - Phone:937-280-2000
Practice Address - Fax:937-280-2051
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-1663568310500000X
OHCOA.18078.NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness