Provider Demographics
NPI:1659079721
Name:MATTES, ALLYSSA MORGAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSSA
Middle Name:MORGAN
Last Name:MATTES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 BLANKET FLOWER LN APT 308
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-8726
Mailing Address - Country:US
Mailing Address - Phone:260-602-1839
Mailing Address - Fax:
Practice Address - Street 1:14220 BLANKET FLOWER LN APT 308
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-8726
Practice Address - Country:US
Practice Address - Phone:260-602-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043674A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical