Provider Demographics
NPI:1497061741
Name:MATTHIAS, WARREN EUGENE (LAC, CAS)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EUGENE
Last Name:MATTHIAS
Suffix:
Gender:M
Credentials:LAC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 'Q' ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-2803
Mailing Address - Country:US
Mailing Address - Phone:812-279-4673
Mailing Address - Fax:
Practice Address - Street 1:2325 Q ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4718
Practice Address - Country:US
Practice Address - Phone:812-279-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000041A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)