Provider Demographics
NPI:1497261101
Name:JUDAH, MATTHEW R (PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:JUDAH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:R
Other - Last Name:JUDAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:216 MEMORIAL HALL
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGICAL SCIENCE
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:757-284-6835
Mailing Address - Fax:
Practice Address - Street 1:19 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6067
Practice Address - Country:US
Practice Address - Phone:479-274-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical