Provider Demographics
NPI:1639551427
Name:MATTHEWS, KARISSA (LMHP, PLADC, LPCC)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LMHP, PLADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 ANDASOL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1017
Mailing Address - Country:US
Mailing Address - Phone:858-204-4136
Mailing Address - Fax:
Practice Address - Street 1:8610 BRENTWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3377
Practice Address - Country:US
Practice Address - Phone:402-331-3232
Practice Address - Fax:402-331-1557
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4896101YM0800X
NE10573101YA0400X
CA4825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$01Medicaid