Provider Demographics
NPI:1518354315
Name:MATTHEWS, JEANETTE NICOLE (LMFT, LADC)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:NICOLE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 HENNEPIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-4035
Mailing Address - Country:US
Mailing Address - Phone:952-903-1359
Mailing Address - Fax:612-584-4495
Practice Address - Street 1:111 HUNDERTMARK RD STE 205N
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1586
Practice Address - Country:US
Practice Address - Phone:952-903-1376
Practice Address - Fax:952-426-3856
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302803101YA0400X
MN2740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)