Provider Demographics
NPI:1609556208
Name:WEBSTER, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14541 FOLKESTONE ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NE
Mailing Address - Zip Code:68462-1594
Mailing Address - Country:US
Mailing Address - Phone:402-525-1744
Mailing Address - Fax:
Practice Address - Street 1:610 J ST STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2967
Practice Address - Country:US
Practice Address - Phone:402-937-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health