Provider Demographics
NPI:1609315399
Name:MATIER, LUCY JO (RBT)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:JO
Last Name:MATIER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 BALDWIN FARMS PL APT 621
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-6635
Mailing Address - Country:US
Mailing Address - Phone:541-760-4033
Mailing Address - Fax:
Practice Address - Street 1:12786 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2698
Practice Address - Country:US
Practice Address - Phone:251-986-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst