Provider Demographics
NPI:1619691102
Name:MATTHEWS, TAMIKA (MS, LSP)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS, LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 FORTANINI CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5081
Mailing Address - Country:US
Mailing Address - Phone:407-963-8300
Mailing Address - Fax:
Practice Address - Street 1:736 FORTANINI CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5081
Practice Address - Country:US
Practice Address - Phone:407-963-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1528103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool